Release 4 5

This page is part of the FHIR Specification (v4.0.1: R4 (v5.0.0: R5 - Mixed Normative and STU ) ). This is the current published version in it's permanent home (it will always be available at this URL). 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

12.15 12.19 Resource NutritionOrder - Content

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

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

12.15.1 12.19.1 Scope and Usage

This resource is a request resource from a FHIR workflow perspective - see Workflow . It is the intent of the Orders and Observation Workgroup to align this resource with the workflow pattern for request resources .

The NutritionOrder resource describes a request for oral diets (including general diets such as General Healthy diet, or therapeutic diets such as Consistent Carbohydrate, 2 gram Sodium, or Fluid Restricted), oral nutrition supplements (such as nutritionally complete pre-packed drinks), enteral nutrition (tube feedings) and infant formula which govern the distribution of food and nutritional products used to feed patients within an in-patient setting. It does not cover orders for parenteral (IV) nutrition which are typically filled by pharmacy. These nutrition orders are combined with information on a patient's food allergies and intolerances, and ethnic or cultural food preferences (e.g. Kosher or Vegetarian) to inform healthcare personnel about the type, texture, and/or quantity of foods that the patient should receive or consume.

Enteral orders are distinguished from supplements because they have some unique attributes and typically include administration information whereas oral nutritional supplements may simply be supplied (e.g. home health or outpatient settings). In a simple case, the requestor may designate type of product, product name and the route of administration along with free text instructions without a having to complete the additional structured details.

This resource is intended to be used by providers from a variety of specialties such as physicians, dietitian/nutritionists, or speech therapists. One provider may simply order a base element oral diet such as General Healthful diet. Another provider, based on scope of practice, may use other elements to communicate additional therapeutic needs or patient preferences. The optionality included gives an ordering provider the capability to write a simple order for an oral diet, nutritional supplement or formula with minimal requirements beyond that of specifying the diet, supplement or formula product, but also supports the ability to provide more detailed information that may be further augmented by a dietitian or nutrition specialist. For example, a physician may order a 2 g sodium diet. A speech therapist, based on the results of a swallowing evaluation, then orders a mechanically altered texture with nectar thick liquids.

12.15.2 12.19.2 Boundaries and Relationships

The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements and enteral feedings in an in-patient setting. The MedicationRequest resource should be used for requesting parenteral (IV) nutrition and prescribing dietary supplements such as vitamin or mineral supplements.

The Nutrition Order is a record of the request for the supply of a diet, oral supplement or enteral formulas for a patient. However, to initiate the request requires the use of the Task resource and its associated workflow with the Nutrition Order referenced from Task.basedOn, or by using the Nutrition Task resource in the context of a messaging or service workflow where the request is explicit or implicit.

This resource is referenced by

12.19.3 References to this Resource

12.15.3 12.19.4 Resource Content

Structure

The person who
Name Flags Card. Type Description & Constraints doco
. . NutritionOrder I TU DomainResource Diet, formula or nutritional supplement request
+ Warning: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Identifiers assigned to this order

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

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

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

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

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

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

. . . foodPreferenceModifier 0..* CodeableConcept Order-specific modifier about the type of food that should be given
Binding: Diet ( Example )

. . . excludeFoodModifier 0..* CodeableConcept Order-specific modifier about the type of food that should not be given
Binding: Food Type Codes ( Example )

. . . outsideFoodAllowed 0..1 boolean Capture when a food item is brought in by the patient and/or family
.. . oralDiet I C 0..1 BackboneElement Oral diet components
. . . . type Σ 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally
Binding: Diet Codes ( Example )

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

. . . . nutrient . asNeeded 0..1 boolean Take 'as needed'
..... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes ( Example )
.... nutrient 0..* BackboneElement Required nutrient modifications

. . . . . modifier 0..1 CodeableConcept Type of nutrient that is being modified
Binding: Nutrient Modifier Codes ( Example )
. . . . . amount 0..1 SimpleQuantity Quantity of the specified nutrient
. . . . texture 0..* BackboneElement Required texture modifications

. . . . . modifier 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g. pureed
Binding: Texture Modifier Codes ( Example )
. . . . . foodType 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes
Binding: Texture Modified Food Type Codes ( Example )
. . . . fluidConsistencyType 0..* CodeableConcept The required consistency of fluids and liquids provided to the patient
Binding: Fluid Consistency Type Codes ( Example )

. . . . instruction Σ 0..1 string Instructions or additional information about the oral diet
. . . supplement I C 0..* BackboneElement Supplement components

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

. . . . quantity . asNeeded 0..1 boolean Take 'as needed'
..... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes ( Example )
.... quantity 0..1 SimpleQuantity Amount of the nutritional supplement
. . . . instruction Σ 0..1 string Instructions or additional information about the oral supplement
. . . enteralFormula I C 0..1 BackboneElement Enteral formula components
. . . . baseFormulaType Σ 0..1 CodeableConcept CodeableReference ( NutritionProduct ) Type of enteral or infant formula
Binding: Enteral Formula Type Codes ( Example )
. . . . baseFormulaProductName 0..1 string Product or brand name of the enteral or infant formula
. . . additiveType . deliveryDevice 0..* CodeableReference ( DeviceDefinition ) Intended type of device for the administration

.... additive 0..* BackboneElement Components to add to the feeding

..... type 0..1 CodeableConcept CodeableReference ( NutritionProduct ) Type of modular component to add to the feeding
Binding: Enteral Formula Additive Type Code ( Example )
. . . . . additiveProductName productName 0..1 string Product or brand name of the modular additive
. . . . . caloricDensity quantity 0..1 SimpleQuantity Amount of additive to be given or mixed in
.... caloricDensity 0..1 SimpleQuantity Amount of energy per specified volume that is required
. . . routeofAdministration . routeOfAdministration 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract
Binding: Enteral Route Codes ( Extensible )
. . . . administration 0..* BackboneElement Formula feeding instruction as structured data

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

. . . . . quantity . asNeeded 0..1 boolean Take 'as needed'
...... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes ( Example )
. . . . . quantity 0..1 SimpleQuantity The volume of formula to provide
. . . . . rate[x] 0..1 Speed with which the formula is provided per period of time
. . . . . . rateQuantity SimpleQuantity
. . . . . . rateRatio Ratio
. . . . maxVolumeToDeliver 0..1 SimpleQuantity Upper limit on formula volume per unit of time
. . . . administrationInstruction Σ 0..1 string markdown Formula feeding instructions expressed as text
. . . note 0..* Annotation Comments


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

NutritionOrder ( DomainResource ) Identifiers assigned to this order by the order sender or by the order receiver identifier : Identifier [0..*] The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder instantiatesCanonical : canonical [0..*] « ActivityDefinition | PlanDefinition » The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder instantiatesUri : uri [0..*] The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder instantiates : uri [0..*] A plan or request that is fulfilled in whole or in part by this nutrition order basedOn : Reference [0..*] « CarePlan | NutritionOrder | ServiceRequest » A shared identifier common to all nutrition orders that were authorized more or less simultaneously by a single author, representing the composite or group identifier groupIdentifier : Identifier [0..1] The workflow status of the nutrition order/request (this element modifies the meaning of other elements) status : code [1..1] « Codes identifying the lifecycle stage of the nutrition order. null (Strength=Required) RequestStatus ! » Indicates the level of authority/intentionality associated with the NutrionOrder and where the request fits into the workflow chain (this element modifies the meaning of other elements) intent : code [1..1] « Codes indicating null (Strength=Required) RequestIntent ! » Indicates how quickly the degree of authority/intentionality associated Nutrition Order should be addressed with a nutrition order. respect to other requests priority : code [0..1] « null (Strength=Required) RequestIntent RequestPriority ! » The person (patient) or set of individuals who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feeding patient subject : Reference [1..1] « Patient | Group » An encounter that provides additional information about the healthcare context in which this request is made encounter : Reference [0..1] « Encounter » Information to support fulfilling (i.e. dispensing or administering) of the nutrition, for example, patient height and weight) supportingInformation : Reference [0..*] « Any » The date and time that this nutrition order was requested dateTime : dateTime [1..1] The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedings orderer : Reference [0..1] « Practitioner | PractitionerRole » The specified desired performer of the nutrition order performer : CodeableReference [0..*] « CareTeam | Practitioner | PractitionerRole | RelatedPerson | Patient | Organization » A link to a record of allergies or intolerances which should be included in the nutrition order allergyIntolerance : Reference [0..*] « AllergyIntolerance » 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 foodPreferenceModifier : CodeableConcept [0..*] « Medical, cultural or ethical food preferences to help with catering requirements. null (Strength=Example) Diet EncounterDiet ?? » This modifier is used to convey Order-specific modifier about the type of oral food or oral fluids 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 excludeFoodModifier : CodeableConcept [0..*] « Codes null (Strength=Example) FoodTypeCodes ?? » This modifier is used to indicate the type of convey whether a food that should NOT item is allowed to be given brought in by the patient and/or family. If set to true, indicates that the patient. (Strength=Example) receiving system does not need to supply the food item FoodTypeCodes outsideFoodAllowed ?? » : boolean [0..1] Comments made about the {{title}} by the requester, performer, subject or other participants note : Annotation [0..*] OralDiet The kind of diet or dietary restriction such as fiber restricted diet or diabetic diet type : CodeableConcept [0..*] « Codes used to indicate the type of diet being ordered for a patient. null (Strength=Example) DietCodes ?? » 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 schedule : Timing [0..*] The required consistency (e.g. honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patient fluidConsistencyType : CodeableConcept [0..*] « Codes used to represent the consistency of fluids and liquids provided to the patient. null (Strength=Example) FluidConsistencyTypeCodes ?? » Free text or additional instructions or information pertaining to the oral diet instruction : string [0..1] OralDietSchedule 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 timing : Timing [0..*] Indicates whether the product is only taken when needed within a specific dosing schedule asNeeded : boolean [0..1] Indicates whether the product is only taken based on a precondition for taking the product asNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming a nutrition product. (Strength=Example) SNOMEDCTMedicationAsNeededRea... ?? » Nutrient The nutrient that is being modified such as carbohydrate or sodium modifier : CodeableConcept [0..1] « Codes for types of nutrients that are being modified such as carbohydrate or sodium. null (Strength=Example) NutrientModifierCodes ?? » The quantity of the specified nutrient to include in diet amount : Quantity ( SimpleQuantity ) [0..1] Texture Any texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureed modifier : CodeableConcept [0..1] « Codes for food consistency types or texture modifications to apply to foods. null (Strength=Example) TextureModifierCodes ?? » The food type(s) (e.g. meats, all foods) that the texture modification applies to. This could be all foods types foodType : CodeableConcept [0..1] « Codes for types of foods that are texture-modified. null (Strength=Example) TextureModifiedFoodTypeCodes ?? » Supplement The kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplement type : CodeableConcept CodeableReference [0..1] « NutritionProduct ; Codes for nutritional supplements to be provided to the patient. null (Strength=Example) SupplementTypeCodes ?? » The product or brand name of the nutritional supplement such as "Acme Protein Shake" productName : string [0..1] The amount of the nutritional supplement to be given quantity : Quantity ( SimpleQuantity ) [0..1] Free text or additional instructions or information pertaining to the oral supplement instruction : string [0..1] SupplementSchedule 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 schedule timing : Timing [0..*] The amount of Indicates whether the nutritional supplement to be given is only taken when needed within a specific dosing schedule quantity asNeeded : Quantity ( SimpleQuantity boolean ) [0..1] Free text or additional instructions or information pertaining to Indicates whether the supplement is only taken based on a precondition for taking the oral supplement instruction asNeededFor : string CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming a supplement. (Strength=Example) SNOMEDCTMedicationAsNeededRea... ?? » EnteralFormula The type of enteral or infant formula such as an adult standard formula with fiber or a soy-based infant formula baseFormulaType : CodeableConcept CodeableReference [0..1] « NutritionProduct ; Codes for type of enteral formula to be administered to patient. null (Strength=Example) EnteralFormulaTypeCodes ?? » The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula" baseFormulaProductName : string [0..1] 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 the base formula additiveType : CodeableConcept [0..1] « Codes used for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula. (Strength=Example) EnteralFormulaAdditiveTypeCode ?? » The product or brand name of the type administration of modular component to be added to the enteral formula additiveProductName deliveryDevice : string CodeableReference [0..1] [0..*] « DeviceDefinition » 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 that provides 24 calories per fluid ounce or an adult may require an enteral formula that provides 1.5 calorie/mL caloricDensity : Quantity ( SimpleQuantity ) [0..1] The route or physiological path of administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tube routeofAdministration routeOfAdministration : CodeableConcept [0..1] « Codes specifying the route of administration of enteral formula. null (Strength=Extensible) EnteralRouteCodes + » The maximum total quantity of formula that may be administered to a subject over the period of time, e.g. 1440 mL over 24 hours maxVolumeToDeliver : Quantity ( SimpleQuantity ) [0..1] Free text formula administration, feeding instructions or additional instructions or information administrationInstruction : string markdown [0..1] Additive 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 type : CodeableReference [0..1] « NutritionProduct ; null (Strength=Example) Administration EnteralFormulaAdditiveTypeCode ?? » The time period and frequency at which product or brand name of the type of modular component to be added to the enteral formula should productName : string [0..1] The amount of additive to be delivered given in addition or to be mixed in with the patient base formula schedule quantity : Timing Quantity ( SimpleQuantity ) [0..1] Administration The volume of formula to provide to the patient per the specified administration schedule quantity : Quantity ( SimpleQuantity ) [0..1] The rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedule rate[x] : Type DataType [0..1] « Quantity ( SimpleQuantity )| Ratio » EnteralFormulaSchedule The time period and frequency at which the enteral formula should be given. The enteral formula should be given for the combination of all schedules if more than one schedule is present timing : Timing [0..*] Indicates whether the enteral formula is only taken when needed within a specific dosing schedule asNeeded : boolean [0..1] Indicates whether the enteral formula is only taken based on a precondition for taking the enteral formula asNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming an enteral formula. (Strength=Example) SNOMEDCTMedicationAsNeededRea... ?? » Schedule information for an oral diet schedule [0..1] Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet nutrient [0..*] Class that describes any texture modifications required for the patient to safely consume various types of solid foods texture [0..*] Diet given orally in contrast to enteral (tube) feeding oralDiet [0..1] Schedule information for a supplement schedule [0..1] Oral nutritional products given in order to add further nutritional value to the patient's diet supplement [0..*] Indicates modular components to be provided in addition or mixed with the base formula additive [0..*] Schedule information for an enteral formula schedule [0..1] 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 this would be an instruction to increase the rate of continuous feeding every 2 hours administration [0..*] Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavity enteralFormula [0..1]

XML Template 

<NutritionOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <instantiates value="[uri]"/><!-- 0..* Instantiates protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|NutritionOrder|ServiceRequest) What this order fulfills --></basedOn>
 <groupIdentifier><!-- 0..1 Identifier Composite Request ID --></groupIdentifier>

 <status value="[code]"/><!-- 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option -->
 <</patient>

 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <subject><!-- 1..1 Reference(Group|Patient) Who requires the diet, formula or nutritional supplement --></subject>

 <encounter><!-- 0..1 Reference(Encounter) The encounter associated with this nutrition order --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Information to support fulfilling of the nutrition order --></supportingInformation>

 <dateTime value="[dateTime]"/><!-- 1..1 Date and time the nutrition order was requested -->
 <orderer><!-- 0..1 Reference(Practitioner|PractitionerRole) Who ordered the diet, formula or nutritional supplement --></orderer>
 <performer><!-- 0..* CodeableReference(CareTeam|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) Who is desired to perform the administration of what is being ordered --></performer>
 <allergyIntolerance><!-- 0..* Reference(AllergyIntolerance) List of the patient's food and nutrition-related allergies and intolerances --></allergyIntolerance>
 <foodPreferenceModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should be given --></foodPreferenceModifier>
 <</excludeFoodModifier>
 <

 <excludeFoodModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should not be given --></excludeFoodModifier>
 <outsideFoodAllowed value="[boolean]"/><!-- 0..1 Capture when a food item is brought in by the patient and/or family -->
 <oralDiet>  <!-- I 0..1 Oral diet components -->

  <type><!-- 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally --></type>
  <</schedule>

  <schedule>  <!-- 0..1 Scheduling information for oral diets -->
   <timing><!-- 0..* Timing Scheduled frequency of diet --></timing>
   <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
   <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
  </schedule>

  <nutrient>  <!-- 0..* Required  nutrient modifications -->
   <modifier><!-- 0..1 CodeableConcept Type of nutrient that is being modified --></modifier>
   <amount><!-- 0..1 Quantity(SimpleQuantity) Quantity of the specified nutrient --></amount>
  </nutrient>
  <texture>  <!-- 0..* Required  texture modifications -->
   <modifier><!-- 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g. pureed --></modifier>
   <foodType><!-- 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes --></foodType>
  </texture>
  <fluidConsistencyType><!-- 0..* CodeableConcept The required consistency of fluids and liquids provided to the patient --></fluidConsistencyType>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral diet -->
 </oralDiet>
 <
  <</type>

 <supplement>  <!-- I 0..* Supplement components -->
  <type><!-- 0..1 CodeableReference(NutritionProduct) Type of supplement product requested --></type>

  <productName value="[string]"/><!-- 0..1 Product or brand name of the nutritional supplement -->
  <</schedule>

  <schedule>  <!-- 0..1 Scheduling information for supplements -->
   <timing><!-- 0..* Timing Scheduled frequency of diet --></timing>
   <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
   <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
  </schedule>

  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of the nutritional supplement --></quantity>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral supplement -->
 </supplement>
 <
  <</baseFormulaType>

 <enteralFormula>  <!-- I 0..1 Enteral formula components -->
  <baseFormulaType><!-- 0..1 CodeableReference(NutritionProduct) Type of enteral or infant formula --></baseFormulaType>

  <baseFormulaProductName value="[string]"/><!-- 0..1 Product or brand name of the enteral or infant formula -->
  <</additiveType>
  <

  <deliveryDevice><!-- 0..* CodeableReference(DeviceDefinition) Intended type of device for the administration --></deliveryDevice>
  <additive>  <!-- 0..* Components to add to the feeding -->
   <type><!-- 0..1 CodeableReference(NutritionProduct) Type of modular component to add to the feeding --></type>
   <productName value="[string]"/><!-- 0..1 Product or brand name of the modular additive -->
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of additive to be given or mixed in --></quantity>
  </additive>

  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume that is required --></caloricDensity>
  <</routeofAdministration>

  <routeOfAdministration><!-- 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract --></routeOfAdministration>

  <administration>  <!-- 0..* Formula feeding instruction as structured data -->
   <</schedule>

   <schedule>  <!-- 0..1 Scheduling information for enteral formula products -->
    <timing><!-- 0..* Timing Scheduled frequency of enteral formula --></timing>
    <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
    <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
   </schedule>

   <quantity><!-- 0..1 Quantity(SimpleQuantity) The volume of formula to provide --></quantity>
   <rate[x]><!-- 0..1 Quantity(SimpleQuantity)|Ratio Speed with which the formula is provided per period of time --></rate[x]>
  </administration>
  <maxVolumeToDeliver><!-- 0..1 Quantity(SimpleQuantity) Upper limit on formula volume per unit of time --></maxVolumeToDeliver>
  <

  <administrationInstruction value="[markdown]"/><!-- 0..1 Formula feeding instructions expressed as text -->

 </enteralFormula>
 <note><!-- 0..* Annotation Comments --></note>
</NutritionOrder>

JSON Template 

{doco
  "resourceType" : "NutritionOrder",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "

  "instantiatesCanonical" : ["<canonical(ActivityDefinition|PlanDefinition)>"], // Instantiates FHIR protocol or definition

  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "instantiates" : ["<uri>"], // Instantiates protocol or definition
  "basedOn" : [{ Reference(CarePlan|NutritionOrder|ServiceRequest) }], // What this order fulfills
  "groupIdentifier" : { Identifier }, // Composite Request ID

  "status" : "<code>", // R!  draft | active | on-hold | revoked | completed | entered-in-error | unknown
  "intent" : "<code>", // R!  proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  "

  "priority" : "<code>", // routine | urgent | asap | stat
  "subject" : { Reference(Group|Patient) }, // R!  Who requires the diet, formula or nutritional supplement

  "encounter" : { Reference(Encounter) }, // The encounter associated with this nutrition order
  "supportingInformation" : [{ Reference(Any) }], // Information to support fulfilling of the nutrition order

  "dateTime" : "<dateTime>", // R!  Date and time the nutrition order was requested
  "orderer" : { Reference(Practitioner|PractitionerRole) }, // Who ordered the diet, formula or nutritional supplement
  "performer" : [{ CodeableReference(CareTeam|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) }], // Who is desired to perform the administration of what is being ordered
  "allergyIntolerance" : [{ Reference(AllergyIntolerance) }], // List of the patient's food and nutrition-related allergies and intolerances
  "foodPreferenceModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should be given
  "
  "

  "excludeFoodModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should not be given
  "outsideFoodAllowed" : <boolean>, // Capture when a food item is brought in by the patient and/or family
  "oralDiet" : { // I Oral diet components

    "type" : [{ CodeableConcept }], // Type of oral diet or diet restrictions that describe what can be consumed orally
    "

    "schedule" : { // Scheduling information for oral diets
      "timing" : [{ Timing }], // Scheduled frequency of diet
      "asNeeded" : <boolean>, // Take 'as needed'
      "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
    },

    "nutrient" : [{ // Required  nutrient modifications
      "modifier" : { CodeableConcept }, // Type of nutrient that is being modified
      "amount" : { Quantity(SimpleQuantity) } // Quantity of the specified nutrient
    }],
    "texture" : [{ // Required  texture modifications
      "modifier" : { CodeableConcept }, // Code to indicate how to alter the texture of the foods, e.g. pureed
      "foodType" : { CodeableConcept } // Concepts that are used to identify an entity that is ingested for nutritional purposes
    }],
    "fluidConsistencyType" : [{ CodeableConcept }], // The required consistency of fluids and liquids provided to the patient
    "instruction" : "<string>" // Instructions or additional information about the oral diet
  },
  "
    "

  "supplement" : [{ // I Supplement components
    "type" : { CodeableReference(NutritionProduct) }, // Type of supplement product requested

    "productName" : "<string>", // Product or brand name of the nutritional supplement
    "

    "schedule" : { // Scheduling information for supplements
      "timing" : [{ Timing }], // Scheduled frequency of diet
      "asNeeded" : <boolean>, // Take 'as needed'
      "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
    },

    "quantity" : { Quantity(SimpleQuantity) }, // Amount of the nutritional supplement
    "instruction" : "<string>" // Instructions or additional information about the oral supplement
  }],
  "
    "

  "enteralFormula" : { // I Enteral formula components
    "baseFormulaType" : { CodeableReference(NutritionProduct) }, // Type of enteral or infant formula

    "baseFormulaProductName" : "<string>", // Product or brand name of the enteral or infant formula
    "
    "

    "deliveryDevice" : [{ CodeableReference(DeviceDefinition) }], // Intended type of device for the administration
    "additive" : [{ // Components to add to the feeding
      "type" : { CodeableReference(NutritionProduct) }, // Type of modular component to add to the feeding
      "productName" : "<string>", // Product or brand name of the modular additive
      "quantity" : { Quantity(SimpleQuantity) } // Amount of additive to be given or mixed in
    }],

    "caloricDensity" : { Quantity(SimpleQuantity) }, // Amount of energy per specified volume that is required
    "

    "routeOfAdministration" : { CodeableConcept }, // How the formula should enter the patient's gastrointestinal tract

    "administration" : [{ // Formula feeding instruction as structured data
      "

      "schedule" : { // Scheduling information for enteral formula products
        "timing" : [{ Timing }], // Scheduled frequency of enteral formula
        "asNeeded" : <boolean>, // Take 'as needed'
        "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
      },

      "quantity" : { Quantity(SimpleQuantity) }, // The volume of formula to provide
      // rate[x]: Speed with which the formula is provided per period of time. One of these 2:
      " }

      "rateQuantity" : { Quantity(SimpleQuantity) },

      "rateRatio" : { Ratio }
    }],
    "maxVolumeToDeliver" : { Quantity(SimpleQuantity) }, // Upper limit on formula volume per unit of time
    "

    "administrationInstruction" : "<markdown>" // Formula feeding instructions expressed as text

  },
  "note" : [{ Annotation }] // Comments
}

Turtle Template 

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


[ a fhir:NutritionOrder;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:
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    ], ...;
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    ], ...;
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  ];
  fhir:
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  ], ...;
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    fhir:
      fhir:
      fhir:
      # . One of these 2
        fhir:) ]
        fhir: ]
    ], ...;
    fhir:
    fhir:
  ];
  fhir:

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Identifiers assigned to this order
  fhir:instantiatesCanonical  ( [ canonical(ActivityDefinition|PlanDefinition) ] ... ) ; # 0..* Instantiates FHIR protocol or definition
  fhir:instantiatesUri  ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition
  fhir:instantiates  ( [ uri ] ... ) ; # 0..* Instantiates protocol or definition
  fhir:basedOn  ( [ Reference(CarePlan|NutritionOrder|ServiceRequest) ] ... ) ; # 0..* What this order fulfills
  fhir:groupIdentifier [ Identifier ] ; # 0..1 Composite Request ID
  fhir:status [ code ] ; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown
  fhir:intent [ code ] ; # 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who requires the diet, formula or nutritional supplement
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The encounter associated with this nutrition order
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Information to support fulfilling of the nutrition order
  fhir:dateTime [ dateTime ] ; # 1..1 Date and time the nutrition order was requested
  fhir:orderer [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Who ordered the diet, formula or nutritional supplement
  fhir:performer  ( [ CodeableReference(CareTeam|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who is desired to perform the administration of what is being ordered
  fhir:allergyIntolerance  ( [ Reference(AllergyIntolerance) ] ... ) ; # 0..* List of the patient's food and nutrition-related allergies and intolerances
  fhir:foodPreferenceModifier  ( [ CodeableConcept ] ... ) ; # 0..* Order-specific modifier about the type of food that should be given
  fhir:excludeFoodModifier  ( [ CodeableConcept ] ... ) ; # 0..* Order-specific modifier about the type of food that should not be given
  fhir:outsideFoodAllowed [ boolean ] ; # 0..1 Capture when a food item is brought in by the patient and/or family
  fhir:oralDiet [ # 0..1 I Oral diet components
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type of oral diet or diet restrictions that describe what can be consumed orally
    fhir:schedule [ # 0..1 Scheduling information for oral diets
      fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of diet
      fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
      fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
    ] ;
    fhir:nutrient ( [ # 0..* Required  nutrient modifications
      fhir:modifier [ CodeableConcept ] ; # 0..1 Type of nutrient that is being modified
      fhir:amount [ Quantity(SimpleQuantity) ] ; # 0..1 Quantity of the specified nutrient
    ] ... ) ;
    fhir:texture ( [ # 0..* Required  texture modifications
      fhir:modifier [ CodeableConcept ] ; # 0..1 Code to indicate how to alter the texture of the foods, e.g. pureed
      fhir:foodType [ CodeableConcept ] ; # 0..1 Concepts that are used to identify an entity that is ingested for nutritional purposes
    ] ... ) ;
    fhir:fluidConsistencyType  ( [ CodeableConcept ] ... ) ; # 0..* The required consistency of fluids and liquids provided to the patient
    fhir:instruction [ string ] ; # 0..1 Instructions or additional information about the oral diet
  ] ;
  fhir:supplement ( [ # 0..* I Supplement components
    fhir:type [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of supplement product requested
    fhir:productName [ string ] ; # 0..1 Product or brand name of the nutritional supplement
    fhir:schedule [ # 0..1 Scheduling information for supplements
      fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of diet
      fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
      fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
    ] ;
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of the nutritional supplement
    fhir:instruction [ string ] ; # 0..1 Instructions or additional information about the oral supplement
  ] ... ) ;
  fhir:enteralFormula [ # 0..1 I Enteral formula components
    fhir:baseFormulaType [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of enteral or infant formula
    fhir:baseFormulaProductName [ string ] ; # 0..1 Product or brand name of the enteral or infant formula
    fhir:deliveryDevice  ( [ CodeableReference(DeviceDefinition) ] ... ) ; # 0..* Intended type of device for the administration
    fhir:additive ( [ # 0..* Components to add to the feeding
      fhir:type [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of modular component to add to the feeding
      fhir:productName [ string ] ; # 0..1 Product or brand name of the modular additive
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of additive to be given or mixed in
    ] ... ) ;
    fhir:caloricDensity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of energy per specified volume that is required
    fhir:routeOfAdministration [ CodeableConcept ] ; # 0..1 How the formula should enter the patient's gastrointestinal tract
    fhir:administration ( [ # 0..* Formula feeding instruction as structured data
      fhir:schedule [ # 0..1 Scheduling information for enteral formula products
        fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of enteral formula
        fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
        fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
      ] ;
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 The volume of formula to provide
      # rate[x] : 0..1 Speed with which the formula is provided per period of time. One of these 2
        fhir:rate [  a fhir:SimpleQuantity ; Quantity(SimpleQuantity) ]
        fhir:rate [  a fhir:Ratio ; Ratio ]
    ] ... ) ;
    fhir:maxVolumeToDeliver [ Quantity(SimpleQuantity) ] ; # 0..1 Upper limit on formula volume per unit of time
    fhir:administrationInstruction [ markdown ] ; # 0..1 Formula feeding instructions expressed as text
  ] ;
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments

]

Changes since R3 from both R4 and R4B

NutritionOrder
NutritionOrder.basedOn
  • Added Element
NutritionOrder.instantiatesCanonical NutritionOrder.groupIdentifier
  • Added Element
NutritionOrder.instantiatesUri NutritionOrder.priority
  • Added Element
NutritionOrder.instantiates NutritionOrder.subject
  • Added Mandatory Element
NutritionOrder.supportingInformation
  • Added Element
NutritionOrder.performer
  • Added Element
NutritionOrder.outsideFoodAllowed
  • Added Element
NutritionOrder.status NutritionOrder.oralDiet.schedule
  • Min Max Cardinality changed from 0 * to 1
  • Change value set Type changed from http://hl7.org/fhir/ValueSet/nutrition-request-status Timing to http://hl7.org/fhir/ValueSet/request-status|4.0.1 BackboneElement
NutritionOrder.intent NutritionOrder.oralDiet.schedule.timing
  • Added Mandatory Element
NutritionOrder.oralDiet.schedule.asNeeded
  • Added Element
NutritionOrder.oralDiet.schedule.asNeededFor
  • Added Element
NutritionOrder.orderer NutritionOrder.supplement.type
  • Type Reference: Added Target changed from CodeableConcept to CodeableReference
NutritionOrder.supplement.schedule
  • Max Cardinality changed from * to 1
  • Type PractitionerRole changed from Timing to BackboneElement
NutritionOrder.supplement.schedule.timing
  • Added Element
NutritionOrder.supplement.schedule.asNeeded
  • Added Element
NutritionOrder.supplement.schedule.asNeededFor
  • Added Element
NutritionOrder.enteralFormula.administration.rate[x] NutritionOrder.enteralFormula.baseFormulaType
  • Add Type Quantity() changed from CodeableConcept to CodeableReference
NutritionOrder.enteralFormula.deliveryDevice
  • Added Element
NutritionOrder.enteralFormula.additive
  • Added Element
NutritionOrder.enteralFormula.additive.type
  • Added Element
NutritionOrder.enteralFormula.additive.productName
  • Added Element
NutritionOrder.enteralFormula.additive.quantity
  • Added Element
NutritionOrder.enteralFormula.routeOfAdministration
  • Added Element
NutritionOrder.enteralFormula.administration.schedule
  • Remove Type Quantity() changed from Timing to BackboneElement
NutritionOrder.note NutritionOrder.enteralFormula.administration.schedule.timing
  • Added Element
NutritionOrder.enteralFormula.administration.schedule.asNeeded
  • Added Element
NutritionOrder.enteralFormula.administration.schedule.asNeededFor
  • Added Element
NutritionOrder.enteralFormula.administrationInstruction
  • Type changed from string to markdown
NutritionOrder.patient
  • Deleted
NutritionOrder.enteralFormula.additiveType
  • Deleted
NutritionOrder.enteralFormula.additiveProductName
  • Deleted
NutritionOrder.enteralFormula.routeofAdministration
  • Deleted

See the Full Difference for further information

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

See R3 <--> R4 <--> R5 Conversion Maps (status = 13 tests that all execute ok. All tests pass round-trip testing and 13 r3 resources are invalid (0 errors). ) See Conversions Summary .)

Structure

The person who
Name Flags Card. Type Description & Constraints doco
. . NutritionOrder I TU DomainResource Diet, formula or nutritional supplement request
+ Warning: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class

Elements defined in Ancestors: id , meta , implicitRules , language , text , contained , extension , modifierExtension
. . . identifier 0..* Identifier Identifiers assigned to this order

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

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

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

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

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

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

. . . foodPreferenceModifier 0..* CodeableConcept Order-specific modifier about the type of food that should be given
Binding: Diet ( Example )

. . . excludeFoodModifier 0..* CodeableConcept Order-specific modifier about the type of food that should not be given
Binding: Food Type Codes ( Example )

. . . outsideFoodAllowed 0..1 boolean Capture when a food item is brought in by the patient and/or family
.. . oralDiet I C 0..1 BackboneElement Oral diet components
. . . . type Σ 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally
Binding: Diet Codes ( Example )

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

. . . . nutrient . asNeeded 0..1 boolean Take 'as needed'
..... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes ( Example )
.... nutrient 0..* BackboneElement Required nutrient modifications

. . . . . modifier 0..1 CodeableConcept Type of nutrient that is being modified
Binding: Nutrient Modifier Codes ( Example )
. . . . . amount 0..1 SimpleQuantity Quantity of the specified nutrient
. . . . texture 0..* BackboneElement Required texture modifications

. . . . . modifier 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g. pureed
Binding: Texture Modifier Codes ( Example )
. . . . . foodType 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes
Binding: Texture Modified Food Type Codes ( Example )
. . . . fluidConsistencyType 0..* CodeableConcept The required consistency of fluids and liquids provided to the patient
Binding: Fluid Consistency Type Codes ( Example )

. . . . instruction Σ 0..1 string Instructions or additional information about the oral diet
. . . supplement I C 0..* BackboneElement Supplement components

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

. . . . quantity . asNeeded 0..1 boolean Take 'as needed'
..... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes ( Example )
.... quantity 0..1 SimpleQuantity Amount of the nutritional supplement
. . . . instruction Σ 0..1 string Instructions or additional information about the oral supplement
. . . enteralFormula I C 0..1 BackboneElement Enteral formula components
. . . . baseFormulaType Σ 0..1 CodeableConcept CodeableReference ( NutritionProduct ) Type of enteral or infant formula
Binding: Enteral Formula Type Codes ( Example )
. . . . baseFormulaProductName 0..1 string Product or brand name of the enteral or infant formula
. . . additiveType . deliveryDevice 0..* CodeableReference ( DeviceDefinition ) Intended type of device for the administration

.... additive 0..* BackboneElement Components to add to the feeding

. . . . . type 0..1 CodeableConcept CodeableReference ( NutritionProduct ) Type of modular component to add to the feeding
Binding: Enteral Formula Additive Type Code ( Example )
. . . . . additiveProductName productName 0..1 string Product or brand name of the modular additive
. . . . . caloricDensity quantity 0..1 SimpleQuantity Amount of additive to be given or mixed in
.... caloricDensity 0..1 SimpleQuantity Amount of energy per specified volume that is required
. . . routeofAdministration . routeOfAdministration 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract
Binding: Enteral Route Codes ( Extensible )
. . . . administration 0..* BackboneElement Formula feeding instruction as structured data

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

. . . . . quantity . asNeeded 0..1 boolean Take 'as needed'
...... asNeededFor 0..1 CodeableConcept Take 'as needed' for x
Binding: SNOMED CT Medication As Needed Reason Codes ( Example )
..... quantity 0..1 SimpleQuantity The volume of formula to provide
. . . . . rate[x] 0..1 Speed with which the formula is provided per period of time
. . . . . . rateQuantity SimpleQuantity
. . . . . . rateRatio Ratio
. . . . maxVolumeToDeliver 0..1 SimpleQuantity Upper limit on formula volume per unit of time
. . . . administrationInstruction Σ 0..1 string markdown Formula feeding instructions expressed as text
. . . note 0..* Annotation Comments


doco Documentation for this format icon

See the Extensions for this resource

UML Diagram ( Legend )

NutritionOrder ( DomainResource ) Identifiers assigned to this order by the order sender or by the order receiver identifier : Identifier [0..*] The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder instantiatesCanonical : canonical [0..*] « ActivityDefinition | PlanDefinition » The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder instantiatesUri : uri [0..*] The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder instantiates : uri [0..*] A plan or request that is fulfilled in whole or in part by this nutrition order basedOn : Reference [0..*] « CarePlan | NutritionOrder | ServiceRequest » A shared identifier common to all nutrition orders that were authorized more or less simultaneously by a single author, representing the composite or group identifier groupIdentifier : Identifier [0..1] The workflow status of the nutrition order/request (this element modifies the meaning of other elements) status : code [1..1] « Codes identifying the lifecycle stage of the nutrition order. null (Strength=Required) RequestStatus ! » Indicates the level of authority/intentionality associated with the NutrionOrder and where the request fits into the workflow chain (this element modifies the meaning of other elements) intent : code [1..1] « Codes indicating null (Strength=Required) RequestIntent ! » Indicates how quickly the degree of authority/intentionality associated Nutrition Order should be addressed with a nutrition order. respect to other requests priority : code [0..1] « null (Strength=Required) RequestIntent RequestPriority ! » The person (patient) or set of individuals who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feeding patient subject : Reference [1..1] « Patient | Group » An encounter that provides additional information about the healthcare context in which this request is made encounter : Reference [0..1] « Encounter » Information to support fulfilling (i.e. dispensing or administering) of the nutrition, for example, patient height and weight) supportingInformation : Reference [0..*] « Any » The date and time that this nutrition order was requested dateTime : dateTime [1..1] The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedings orderer : Reference [0..1] « Practitioner | PractitionerRole » The specified desired performer of the nutrition order performer : CodeableReference [0..*] « CareTeam | Practitioner | PractitionerRole | RelatedPerson | Patient | Organization » A link to a record of allergies or intolerances which should be included in the nutrition order allergyIntolerance : Reference [0..*] « AllergyIntolerance » 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 foodPreferenceModifier : CodeableConcept [0..*] « Medical, cultural or ethical food preferences to help with catering requirements. null (Strength=Example) Diet EncounterDiet ?? » This modifier is used to convey Order-specific modifier about the type of oral food or oral fluids 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 excludeFoodModifier : CodeableConcept [0..*] « Codes null (Strength=Example) FoodTypeCodes ?? » This modifier is used to indicate the type of convey whether a food that should NOT item is allowed to be given brought in by the patient and/or family. If set to true, indicates that the patient. (Strength=Example) receiving system does not need to supply the food item FoodTypeCodes outsideFoodAllowed ?? » : boolean [0..1] Comments made about the {{title}} by the requester, performer, subject or other participants note : Annotation [0..*] OralDiet The kind of diet or dietary restriction such as fiber restricted diet or diabetic diet type : CodeableConcept [0..*] « Codes used to indicate the type of diet being ordered for a patient. null (Strength=Example) DietCodes ?? » 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 schedule : Timing [0..*] The required consistency (e.g. honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patient fluidConsistencyType : CodeableConcept [0..*] « Codes used to represent the consistency of fluids and liquids provided to the patient. null (Strength=Example) FluidConsistencyTypeCodes ?? » Free text or additional instructions or information pertaining to the oral diet instruction : string [0..1] OralDietSchedule 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 timing : Timing [0..*] Indicates whether the product is only taken when needed within a specific dosing schedule asNeeded : boolean [0..1] Indicates whether the product is only taken based on a precondition for taking the product asNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming a nutrition product. (Strength=Example) SNOMEDCTMedicationAsNeededRea... ?? » Nutrient The nutrient that is being modified such as carbohydrate or sodium modifier : CodeableConcept [0..1] « Codes for types of nutrients that are being modified such as carbohydrate or sodium. null (Strength=Example) NutrientModifierCodes ?? » The quantity of the specified nutrient to include in diet amount : Quantity ( SimpleQuantity ) [0..1] Texture Any texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureed modifier : CodeableConcept [0..1] « Codes for food consistency types or texture modifications to apply to foods. null (Strength=Example) TextureModifierCodes ?? » The food type(s) (e.g. meats, all foods) that the texture modification applies to. This could be all foods types foodType : CodeableConcept [0..1] « Codes for types of foods that are texture-modified. null (Strength=Example) TextureModifiedFoodTypeCodes ?? » Supplement The kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplement type : CodeableConcept CodeableReference [0..1] « NutritionProduct ; Codes for nutritional supplements to be provided to the patient. null (Strength=Example) SupplementTypeCodes ?? » The product or brand name of the nutritional supplement such as "Acme Protein Shake" productName : string [0..1] The amount of the nutritional supplement to be given quantity : Quantity ( SimpleQuantity ) [0..1] Free text or additional instructions or information pertaining to the oral supplement instruction : string [0..1] SupplementSchedule 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 schedule timing : Timing [0..*] The amount of Indicates whether the nutritional supplement to be given is only taken when needed within a specific dosing schedule quantity asNeeded : Quantity ( SimpleQuantity boolean ) [0..1] Free text or additional instructions or information pertaining to Indicates whether the supplement is only taken based on a precondition for taking the oral supplement instruction asNeededFor : string CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming a supplement. (Strength=Example) SNOMEDCTMedicationAsNeededRea... ?? » EnteralFormula The type of enteral or infant formula such as an adult standard formula with fiber or a soy-based infant formula baseFormulaType : CodeableConcept CodeableReference [0..1] « NutritionProduct ; Codes for type of enteral formula to be administered to patient. null (Strength=Example) EnteralFormulaTypeCodes ?? » The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula" baseFormulaProductName : string [0..1] 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 the base formula additiveType : CodeableConcept [0..1] « Codes used for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula. (Strength=Example) EnteralFormulaAdditiveTypeCode ?? » The product or brand name of the type administration of modular component to be added to the enteral formula additiveProductName deliveryDevice : string CodeableReference [0..1] [0..*] « DeviceDefinition » 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 that provides 24 calories per fluid ounce or an adult may require an enteral formula that provides 1.5 calorie/mL caloricDensity : Quantity ( SimpleQuantity ) [0..1] The route or physiological path of administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tube routeofAdministration routeOfAdministration : CodeableConcept [0..1] « Codes specifying the route of administration of enteral formula. null (Strength=Extensible) EnteralRouteCodes + » The maximum total quantity of formula that may be administered to a subject over the period of time, e.g. 1440 mL over 24 hours maxVolumeToDeliver : Quantity ( SimpleQuantity ) [0..1] Free text formula administration, feeding instructions or additional instructions or information administrationInstruction : string markdown [0..1] Additive 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 type : CodeableReference [0..1] « NutritionProduct ; null (Strength=Example) Administration EnteralFormulaAdditiveTypeCode ?? » The time period and frequency at which product or brand name of the type of modular component to be added to the enteral formula should productName : string [0..1] The amount of additive to be delivered given in addition or to be mixed in with the patient base formula schedule quantity : Timing Quantity ( SimpleQuantity ) [0..1] Administration The volume of formula to provide to the patient per the specified administration schedule quantity : Quantity ( SimpleQuantity ) [0..1] The rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedule rate[x] : Type DataType [0..1] « Quantity ( SimpleQuantity )| Ratio » EnteralFormulaSchedule The time period and frequency at which the enteral formula should be given. The enteral formula should be given for the combination of all schedules if more than one schedule is present timing : Timing [0..*] Indicates whether the enteral formula is only taken when needed within a specific dosing schedule asNeeded : boolean [0..1] Indicates whether the enteral formula is only taken based on a precondition for taking the enteral formula asNeededFor : CodeableConcept [0..1] « A coded concept identifying the precondition that should be met or evaluated prior to consuming an enteral formula. (Strength=Example) SNOMEDCTMedicationAsNeededRea... ?? » Schedule information for an oral diet schedule [0..1] Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet nutrient [0..*] Class that describes any texture modifications required for the patient to safely consume various types of solid foods texture [0..*] Diet given orally in contrast to enteral (tube) feeding oralDiet [0..1] Schedule information for a supplement schedule [0..1] Oral nutritional products given in order to add further nutritional value to the patient's diet supplement [0..*] Indicates modular components to be provided in addition or mixed with the base formula additive [0..*] Schedule information for an enteral formula schedule [0..1] 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 this would be an instruction to increase the rate of continuous feeding every 2 hours administration [0..*] Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavity enteralFormula [0..1]

XML Template 

<NutritionOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <instantiatesCanonical><!-- 0..* canonical(ActivityDefinition|PlanDefinition) Instantiates FHIR protocol or definition --></instantiatesCanonical>
 <instantiatesUri value="[uri]"/><!-- 0..* Instantiates external protocol or definition -->
 <instantiates value="[uri]"/><!-- 0..* Instantiates protocol or definition -->
 <basedOn><!-- 0..* Reference(CarePlan|NutritionOrder|ServiceRequest) What this order fulfills --></basedOn>
 <groupIdentifier><!-- 0..1 Identifier Composite Request ID --></groupIdentifier>

 <status value="[code]"/><!-- 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown -->
 <intent value="[code]"/><!-- 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option -->
 <</patient>

 <priority value="[code]"/><!-- 0..1 routine | urgent | asap | stat -->
 <subject><!-- 1..1 Reference(Group|Patient) Who requires the diet, formula or nutritional supplement --></subject>

 <encounter><!-- 0..1 Reference(Encounter) The encounter associated with this nutrition order --></encounter>
 <supportingInformation><!-- 0..* Reference(Any) Information to support fulfilling of the nutrition order --></supportingInformation>

 <dateTime value="[dateTime]"/><!-- 1..1 Date and time the nutrition order was requested -->
 <orderer><!-- 0..1 Reference(Practitioner|PractitionerRole) Who ordered the diet, formula or nutritional supplement --></orderer>
 <performer><!-- 0..* CodeableReference(CareTeam|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) Who is desired to perform the administration of what is being ordered --></performer>
 <allergyIntolerance><!-- 0..* Reference(AllergyIntolerance) List of the patient's food and nutrition-related allergies and intolerances --></allergyIntolerance>
 <foodPreferenceModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should be given --></foodPreferenceModifier>
 <</excludeFoodModifier>
 <

 <excludeFoodModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should not be given --></excludeFoodModifier>
 <outsideFoodAllowed value="[boolean]"/><!-- 0..1 Capture when a food item is brought in by the patient and/or family -->
 <oralDiet>  <!-- I 0..1 Oral diet components -->

  <type><!-- 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally --></type>
  <</schedule>

  <schedule>  <!-- 0..1 Scheduling information for oral diets -->
   <timing><!-- 0..* Timing Scheduled frequency of diet --></timing>
   <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
   <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
  </schedule>

  <nutrient>  <!-- 0..* Required  nutrient modifications -->
   <modifier><!-- 0..1 CodeableConcept Type of nutrient that is being modified --></modifier>
   <amount><!-- 0..1 Quantity(SimpleQuantity) Quantity of the specified nutrient --></amount>
  </nutrient>
  <texture>  <!-- 0..* Required  texture modifications -->
   <modifier><!-- 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g. pureed --></modifier>
   <foodType><!-- 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes --></foodType>
  </texture>
  <fluidConsistencyType><!-- 0..* CodeableConcept The required consistency of fluids and liquids provided to the patient --></fluidConsistencyType>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral diet -->
 </oralDiet>
 <
  <</type>

 <supplement>  <!-- I 0..* Supplement components -->
  <type><!-- 0..1 CodeableReference(NutritionProduct) Type of supplement product requested --></type>

  <productName value="[string]"/><!-- 0..1 Product or brand name of the nutritional supplement -->
  <</schedule>

  <schedule>  <!-- 0..1 Scheduling information for supplements -->
   <timing><!-- 0..* Timing Scheduled frequency of diet --></timing>
   <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
   <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
  </schedule>

  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of the nutritional supplement --></quantity>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral supplement -->
 </supplement>
 <
  <</baseFormulaType>

 <enteralFormula>  <!-- I 0..1 Enteral formula components -->
  <baseFormulaType><!-- 0..1 CodeableReference(NutritionProduct) Type of enteral or infant formula --></baseFormulaType>

  <baseFormulaProductName value="[string]"/><!-- 0..1 Product or brand name of the enteral or infant formula -->
  <</additiveType>
  <

  <deliveryDevice><!-- 0..* CodeableReference(DeviceDefinition) Intended type of device for the administration --></deliveryDevice>
  <additive>  <!-- 0..* Components to add to the feeding -->
   <type><!-- 0..1 CodeableReference(NutritionProduct) Type of modular component to add to the feeding --></type>
   <productName value="[string]"/><!-- 0..1 Product or brand name of the modular additive -->
   <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of additive to be given or mixed in --></quantity>
  </additive>

  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume that is required --></caloricDensity>
  <</routeofAdministration>

  <routeOfAdministration><!-- 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract --></routeOfAdministration>

  <administration>  <!-- 0..* Formula feeding instruction as structured data -->
   <</schedule>

   <schedule>  <!-- 0..1 Scheduling information for enteral formula products -->
    <timing><!-- 0..* Timing Scheduled frequency of enteral formula --></timing>
    <asNeeded value="[boolean]"/><!-- 0..1 Take 'as needed' -->
    <asNeededFor><!-- 0..1 CodeableConcept Take 'as needed' for x --></asNeededFor>
   </schedule>

   <quantity><!-- 0..1 Quantity(SimpleQuantity) The volume of formula to provide --></quantity>
   <rate[x]><!-- 0..1 Quantity(SimpleQuantity)|Ratio Speed with which the formula is provided per period of time --></rate[x]>
  </administration>
  <maxVolumeToDeliver><!-- 0..1 Quantity(SimpleQuantity) Upper limit on formula volume per unit of time --></maxVolumeToDeliver>
  <

  <administrationInstruction value="[markdown]"/><!-- 0..1 Formula feeding instructions expressed as text -->

 </enteralFormula>
 <note><!-- 0..* Annotation Comments --></note>
</NutritionOrder>

JSON Template 

{doco
  "resourceType" : "NutritionOrder",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "

  "instantiatesCanonical" : ["<canonical(ActivityDefinition|PlanDefinition)>"], // Instantiates FHIR protocol or definition

  "instantiatesUri" : ["<uri>"], // Instantiates external protocol or definition
  "instantiates" : ["<uri>"], // Instantiates protocol or definition
  "basedOn" : [{ Reference(CarePlan|NutritionOrder|ServiceRequest) }], // What this order fulfills
  "groupIdentifier" : { Identifier }, // Composite Request ID

  "status" : "<code>", // R!  draft | active | on-hold | revoked | completed | entered-in-error | unknown
  "intent" : "<code>", // R!  proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  "

  "priority" : "<code>", // routine | urgent | asap | stat
  "subject" : { Reference(Group|Patient) }, // R!  Who requires the diet, formula or nutritional supplement

  "encounter" : { Reference(Encounter) }, // The encounter associated with this nutrition order
  "supportingInformation" : [{ Reference(Any) }], // Information to support fulfilling of the nutrition order

  "dateTime" : "<dateTime>", // R!  Date and time the nutrition order was requested
  "orderer" : { Reference(Practitioner|PractitionerRole) }, // Who ordered the diet, formula or nutritional supplement
  "performer" : [{ CodeableReference(CareTeam|Organization|Patient|
   Practitioner|PractitionerRole|RelatedPerson) }], // Who is desired to perform the administration of what is being ordered
  "allergyIntolerance" : [{ Reference(AllergyIntolerance) }], // List of the patient's food and nutrition-related allergies and intolerances
  "foodPreferenceModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should be given
  "
  "

  "excludeFoodModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should not be given
  "outsideFoodAllowed" : <boolean>, // Capture when a food item is brought in by the patient and/or family
  "oralDiet" : { // I Oral diet components

    "type" : [{ CodeableConcept }], // Type of oral diet or diet restrictions that describe what can be consumed orally
    "

    "schedule" : { // Scheduling information for oral diets
      "timing" : [{ Timing }], // Scheduled frequency of diet
      "asNeeded" : <boolean>, // Take 'as needed'
      "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
    },

    "nutrient" : [{ // Required  nutrient modifications
      "modifier" : { CodeableConcept }, // Type of nutrient that is being modified
      "amount" : { Quantity(SimpleQuantity) } // Quantity of the specified nutrient
    }],
    "texture" : [{ // Required  texture modifications
      "modifier" : { CodeableConcept }, // Code to indicate how to alter the texture of the foods, e.g. pureed
      "foodType" : { CodeableConcept } // Concepts that are used to identify an entity that is ingested for nutritional purposes
    }],
    "fluidConsistencyType" : [{ CodeableConcept }], // The required consistency of fluids and liquids provided to the patient
    "instruction" : "<string>" // Instructions or additional information about the oral diet
  },
  "
    "

  "supplement" : [{ // I Supplement components
    "type" : { CodeableReference(NutritionProduct) }, // Type of supplement product requested

    "productName" : "<string>", // Product or brand name of the nutritional supplement
    "

    "schedule" : { // Scheduling information for supplements
      "timing" : [{ Timing }], // Scheduled frequency of diet
      "asNeeded" : <boolean>, // Take 'as needed'
      "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
    },

    "quantity" : { Quantity(SimpleQuantity) }, // Amount of the nutritional supplement
    "instruction" : "<string>" // Instructions or additional information about the oral supplement
  }],
  "
    "

  "enteralFormula" : { // I Enteral formula components
    "baseFormulaType" : { CodeableReference(NutritionProduct) }, // Type of enteral or infant formula

    "baseFormulaProductName" : "<string>", // Product or brand name of the enteral or infant formula
    "
    "

    "deliveryDevice" : [{ CodeableReference(DeviceDefinition) }], // Intended type of device for the administration
    "additive" : [{ // Components to add to the feeding
      "type" : { CodeableReference(NutritionProduct) }, // Type of modular component to add to the feeding
      "productName" : "<string>", // Product or brand name of the modular additive
      "quantity" : { Quantity(SimpleQuantity) } // Amount of additive to be given or mixed in
    }],

    "caloricDensity" : { Quantity(SimpleQuantity) }, // Amount of energy per specified volume that is required
    "

    "routeOfAdministration" : { CodeableConcept }, // How the formula should enter the patient's gastrointestinal tract

    "administration" : [{ // Formula feeding instruction as structured data
      "

      "schedule" : { // Scheduling information for enteral formula products
        "timing" : [{ Timing }], // Scheduled frequency of enteral formula
        "asNeeded" : <boolean>, // Take 'as needed'
        "asNeededFor" : { CodeableConcept } // Take 'as needed' for x
      },

      "quantity" : { Quantity(SimpleQuantity) }, // The volume of formula to provide
      // rate[x]: Speed with which the formula is provided per period of time. One of these 2:
      " }

      "rateQuantity" : { Quantity(SimpleQuantity) },

      "rateRatio" : { Ratio }
    }],
    "maxVolumeToDeliver" : { Quantity(SimpleQuantity) }, // Upper limit on formula volume per unit of time
    "

    "administrationInstruction" : "<markdown>" // Formula feeding instructions expressed as text

  },
  "note" : [{ Annotation }] // Comments
}

Turtle Template 

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


[ a fhir:NutritionOrder;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
    fhir:
    fhir:
    fhir:
      fhir:
      fhir:
    ], ...;
    fhir:
      fhir:
      fhir:
    ], ...;
    fhir:
    fhir:
  ];
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
  ], ...;
  fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
    fhir:
      fhir:
      fhir:
      # . One of these 2
        fhir:) ]
        fhir: ]
    ], ...;
    fhir:
    fhir:
  ];
  fhir:

  fhir:identifier  ( [ Identifier ] ... ) ; # 0..* Identifiers assigned to this order
  fhir:instantiatesCanonical  ( [ canonical(ActivityDefinition|PlanDefinition) ] ... ) ; # 0..* Instantiates FHIR protocol or definition
  fhir:instantiatesUri  ( [ uri ] ... ) ; # 0..* Instantiates external protocol or definition
  fhir:instantiates  ( [ uri ] ... ) ; # 0..* Instantiates protocol or definition
  fhir:basedOn  ( [ Reference(CarePlan|NutritionOrder|ServiceRequest) ] ... ) ; # 0..* What this order fulfills
  fhir:groupIdentifier [ Identifier ] ; # 0..1 Composite Request ID
  fhir:status [ code ] ; # 1..1 draft | active | on-hold | revoked | completed | entered-in-error | unknown
  fhir:intent [ code ] ; # 1..1 proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
  fhir:priority [ code ] ; # 0..1 routine | urgent | asap | stat
  fhir:subject [ Reference(Group|Patient) ] ; # 1..1 Who requires the diet, formula or nutritional supplement
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 The encounter associated with this nutrition order
  fhir:supportingInformation  ( [ Reference(Any) ] ... ) ; # 0..* Information to support fulfilling of the nutrition order
  fhir:dateTime [ dateTime ] ; # 1..1 Date and time the nutrition order was requested
  fhir:orderer [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Who ordered the diet, formula or nutritional supplement
  fhir:performer  ( [ CodeableReference(CareTeam|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ] ... ) ; # 0..* Who is desired to perform the administration of what is being ordered
  fhir:allergyIntolerance  ( [ Reference(AllergyIntolerance) ] ... ) ; # 0..* List of the patient's food and nutrition-related allergies and intolerances
  fhir:foodPreferenceModifier  ( [ CodeableConcept ] ... ) ; # 0..* Order-specific modifier about the type of food that should be given
  fhir:excludeFoodModifier  ( [ CodeableConcept ] ... ) ; # 0..* Order-specific modifier about the type of food that should not be given
  fhir:outsideFoodAllowed [ boolean ] ; # 0..1 Capture when a food item is brought in by the patient and/or family
  fhir:oralDiet [ # 0..1 I Oral diet components
    fhir:type  ( [ CodeableConcept ] ... ) ; # 0..* Type of oral diet or diet restrictions that describe what can be consumed orally
    fhir:schedule [ # 0..1 Scheduling information for oral diets
      fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of diet
      fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
      fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
    ] ;
    fhir:nutrient ( [ # 0..* Required  nutrient modifications
      fhir:modifier [ CodeableConcept ] ; # 0..1 Type of nutrient that is being modified
      fhir:amount [ Quantity(SimpleQuantity) ] ; # 0..1 Quantity of the specified nutrient
    ] ... ) ;
    fhir:texture ( [ # 0..* Required  texture modifications
      fhir:modifier [ CodeableConcept ] ; # 0..1 Code to indicate how to alter the texture of the foods, e.g. pureed
      fhir:foodType [ CodeableConcept ] ; # 0..1 Concepts that are used to identify an entity that is ingested for nutritional purposes
    ] ... ) ;
    fhir:fluidConsistencyType  ( [ CodeableConcept ] ... ) ; # 0..* The required consistency of fluids and liquids provided to the patient
    fhir:instruction [ string ] ; # 0..1 Instructions or additional information about the oral diet
  ] ;
  fhir:supplement ( [ # 0..* I Supplement components
    fhir:type [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of supplement product requested
    fhir:productName [ string ] ; # 0..1 Product or brand name of the nutritional supplement
    fhir:schedule [ # 0..1 Scheduling information for supplements
      fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of diet
      fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
      fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
    ] ;
    fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of the nutritional supplement
    fhir:instruction [ string ] ; # 0..1 Instructions or additional information about the oral supplement
  ] ... ) ;
  fhir:enteralFormula [ # 0..1 I Enteral formula components
    fhir:baseFormulaType [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of enteral or infant formula
    fhir:baseFormulaProductName [ string ] ; # 0..1 Product or brand name of the enteral or infant formula
    fhir:deliveryDevice  ( [ CodeableReference(DeviceDefinition) ] ... ) ; # 0..* Intended type of device for the administration
    fhir:additive ( [ # 0..* Components to add to the feeding
      fhir:type [ CodeableReference(NutritionProduct) ] ; # 0..1 Type of modular component to add to the feeding
      fhir:productName [ string ] ; # 0..1 Product or brand name of the modular additive
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of additive to be given or mixed in
    ] ... ) ;
    fhir:caloricDensity [ Quantity(SimpleQuantity) ] ; # 0..1 Amount of energy per specified volume that is required
    fhir:routeOfAdministration [ CodeableConcept ] ; # 0..1 How the formula should enter the patient's gastrointestinal tract
    fhir:administration ( [ # 0..* Formula feeding instruction as structured data
      fhir:schedule [ # 0..1 Scheduling information for enteral formula products
        fhir:timing  ( [ Timing ] ... ) ; # 0..* Scheduled frequency of enteral formula
        fhir:asNeeded [ boolean ] ; # 0..1 Take 'as needed'
        fhir:asNeededFor [ CodeableConcept ] ; # 0..1 Take 'as needed' for x
      ] ;
      fhir:quantity [ Quantity(SimpleQuantity) ] ; # 0..1 The volume of formula to provide
      # rate[x] : 0..1 Speed with which the formula is provided per period of time. One of these 2
        fhir:rate [  a fhir:SimpleQuantity ; Quantity(SimpleQuantity) ]
        fhir:rate [  a fhir:Ratio ; Ratio ]
    ] ... ) ;
    fhir:maxVolumeToDeliver [ Quantity(SimpleQuantity) ] ; # 0..1 Upper limit on formula volume per unit of time
    fhir:administrationInstruction [ markdown ] ; # 0..1 Formula feeding instructions expressed as text
  ] ;
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments

]

Changes since Release 3 from both R4 and R4B

NutritionOrder
NutritionOrder.basedOn
  • Added Element
NutritionOrder.instantiatesCanonical NutritionOrder.groupIdentifier
  • Added Element
NutritionOrder.instantiatesUri NutritionOrder.priority
  • Added Element
NutritionOrder.subject
  • Added Mandatory Element
NutritionOrder.instantiates NutritionOrder.supportingInformation
  • Added Element
NutritionOrder.performer
  • Added Element
NutritionOrder.outsideFoodAllowed
  • Added Element
NutritionOrder.status NutritionOrder.oralDiet.schedule
  • Min Max Cardinality changed from 0 * to 1
  • Change value set Type changed from http://hl7.org/fhir/ValueSet/nutrition-request-status Timing to http://hl7.org/fhir/ValueSet/request-status|4.0.1 BackboneElement
NutritionOrder.intent NutritionOrder.oralDiet.schedule.timing
  • Added Mandatory Element
NutritionOrder.oralDiet.schedule.asNeeded
  • Added Element
NutritionOrder.oralDiet.schedule.asNeededFor
  • Added Element
NutritionOrder.orderer NutritionOrder.supplement.type
  • Type Reference: Added Target changed from CodeableConcept to CodeableReference
NutritionOrder.supplement.schedule
  • Max Cardinality changed from * to 1
  • Type PractitionerRole changed from Timing to BackboneElement
NutritionOrder.supplement.schedule.timing
  • Added Element
NutritionOrder.supplement.schedule.asNeeded
  • Added Element
NutritionOrder.supplement.schedule.asNeededFor
  • Added Element
NutritionOrder.enteralFormula.administration.rate[x] NutritionOrder.enteralFormula.baseFormulaType
  • Add Type Quantity() changed from CodeableConcept to CodeableReference
NutritionOrder.enteralFormula.deliveryDevice
  • Added Element
NutritionOrder.enteralFormula.additive
  • Added Element
NutritionOrder.enteralFormula.additive.type
  • Added Element
NutritionOrder.enteralFormula.additive.productName
  • Added Element
NutritionOrder.enteralFormula.additive.quantity
  • Added Element
NutritionOrder.enteralFormula.routeOfAdministration
  • Added Element
NutritionOrder.enteralFormula.administration.schedule
  • Remove Type Quantity() changed from Timing to BackboneElement
NutritionOrder.note NutritionOrder.enteralFormula.administration.schedule.timing
  • Added Element
NutritionOrder.enteralFormula.administration.schedule.asNeeded
  • Added Element
NutritionOrder.enteralFormula.administration.schedule.asNeededFor
  • Added Element
NutritionOrder.enteralFormula.administrationInstruction
  • Type changed from string to markdown
NutritionOrder.patient
  • Deleted
NutritionOrder.enteralFormula.additiveType
  • Deleted
NutritionOrder.enteralFormula.additiveProductName
  • Deleted
NutritionOrder.enteralFormula.routeofAdministration
  • Deleted

See the Full Difference for further information

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

See R3 <--> R4 <--> R5 Conversion Maps (status = 13 tests that all execute ok. All tests pass round-trip testing and 13 r3 resources are invalid (0 errors). ) See Conversions Summary .)

 

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

12.15.3.1 12.19.4.1 Terminology Bindings

NutritionOrder.oralDiet.texture.modifier Example NutritionOrder.oralDiet.texture.foodType Example NutritionOrder.oralDiet.fluidConsistencyType NutritionOrder.supplement.type Example NutritionOrder.enteralFormula.additiveType Example NutritionOrder.enteralFormula.routeofAdministration
Path Definition ValueSet Type Reference Documentation
NutritionOrder.status Codes identifying the lifecycle stage of the nutrition order. RequestStatus Required RequestStatus

Codes identifying the lifecycle stage of a request.

NutritionOrder.intent RequestIntent Required

Codes indicating the degree of authority/intentionality associated with a nutrition order. request.

NutritionOrder.priority RequestPriority Required RequestIntent

Identifies the level of importance to be assigned to actioning the request.

NutritionOrder.foodPreferenceModifier Medical, cultural or ethical food preferences to help with catering requirements. EncounterDiet (a valid code from Diet icon ) Example Diet

This value set defines a set of codes that can be used to indicate dietary preferences or restrictions a patient may have.

NutritionOrder.excludeFoodModifier Codes used to indicate the type of food that should NOT be given to the patient. FoodTypeCodes Example FoodTypeCodes

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

NutritionOrder.oralDiet.type DietCodes Example

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

NutritionOrder.oralDiet.schedule.asNeededFor SNOMEDCTMedicationAsNeededReasonCodes Example DietCodes

This value set includes all clinical findings from SNOMED CT - provided as an exemplar value set.

NutritionOrder.oralDiet.nutrient.modifier NutrientModifierCodes Example

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

NutritionOrder.oralDiet.texture.modifier NutrientModifierCodes TextureModifierCodes Example

TextureModifier: Codes for food consistency types or texture modifications to apply to foods. This value set is composed of SNOMED CT (US Extension and Core) Concepts from SCTID 229961002 Food consistency types (substance) hierarchy and is provided as a suggestive example.

NutritionOrder.oralDiet.texture.foodType TextureModifierCodes TextureModifiedFoodTypeCodes Example

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

NutritionOrder.oralDiet.fluidConsistencyType TextureModifiedFoodTypeCodes FluidConsistencyTypeCodes Example

FluidConsistencyType : Codes used to represent the consistency of fluids and liquids provided to the patient. This value set includes concepts from SNOMED CT icon Example (US Extension) where concept is a 435681000124103 (Dietary liquid consistency diet (regime/therapy)). It is provided as a suggestive example.

NutritionOrder.supplement.type FluidConsistencyTypeCodes SupplementTypeCodes Example

SupplementType : Codes for nutritional supplements to be provided to the patient. This value set is composed of SNOMED CT (US Extension) Concepts from SCTID 470581016 (Enteral+supplement feeds hierarchy (product)) and is provided as a suggestive example.

NutritionOrder.supplement.schedule.asNeededFor SNOMEDCTMedicationAsNeededReasonCodes Example SupplementTypeCodes

This value set includes all clinical findings from SNOMED CT - provided as an exemplar value set.

NutritionOrder.enteralFormula.baseFormulaType EnteralFormulaTypeCodes Example

EnteralFormulaType : Codes for type of enteral formula to be administered to patient. This value set is composed of SNOMED CT (US Extension) Concepts from SCTID 470581016 (Enteral+supplement feeds hierarchy (product)) and is provided as a suggestive example.

NutritionOrder.enteralFormula.additive.type EnteralFormulaTypeCodes EnteralFormulaAdditiveTypeCode Example

EnteralFormulaAdditiveType: 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. This value set is provided as a suggestive example.

NutritionOrder.enteralFormula.routeOfAdministration EnteralFormulaAdditiveTypeCode EnteralRouteCodes Extensible

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

NutritionOrder.enteralFormula.administration.schedule.asNeededFor SNOMEDCTMedicationAsNeededReasonCodes Extensible Example EnteralRouteCodes

This value set includes all clinical findings from SNOMED CT - provided as an exemplar value set.

12.15.3.2 12.19.4.2 Constraints

id UniqueKey Level Location Description Expression
nor-1 img  nor-1 Warning (base) Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class oralDiet.exists() or supplement.exists() or enteralFormula.exists()

12.15.4 12.19.5 Notes:

12.15.4.1 12.19.5.1 Enteral continuous vs. intermittent tube feedings

Tube feedings can be administered via continuous drip using a pump or via intermittent feedings, using gravity drip or a pump. The examples Nutrition Order Enteral Bolus Feeding Example and Nutrition Order Enteral Continuous Feeding Example show how this resource can be used to order both kinds of enteral feeding using the structured data elements. The continuous feeding typically specifies rate of administration and a maximum volume of delivery using the enteralFormula.administration.rate and enteralFormula.maxVolumeToDeliver elements. On the other hand, the intermittent feeding typically specifies the amount and frequency of administration using the enteralFormula.administration.quantity and enteralFormula.schedule elements. In both cases, to vary the rate or quantity over time the enteralFormula.administration element can be repeated.

12.15.4.2 12.19.5.2 Note about the examples

The examples associated with this resource demonstrate the core elements and do not necessarily reflect real world real-world implementations that may be constrained by future profiles for a given implementation or setting. For example, a renal diet is often comprised of pre-coordinated components including common nutrient modifications such as protein, potassium and phosphorus to assist with the speed of entry of complex diet orders.

12.15.5 12.19.6 Search Parameters

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

Name Type Description Expression In Common
additive token Type of module component to add to the feeding NutritionOrder.enteralFormula.additiveType NutritionOrder.enteralFormula.additive.type.concept
datetime date Return nutrition orders requested on this date NutritionOrder.dateTime
encounter reference Return nutrition orders with this encounter identifier NutritionOrder.encounter
( Encounter ) 		12 29 Resources
formula token Type of enteral or infant formula NutritionOrder.enteralFormula.baseFormulaType NutritionOrder.enteralFormula.baseFormulaType.concept
identifier group-identifier token Return nutrition orders with this external identifier Composite Request ID NutritionOrder.identifier NutritionOrder.groupIdentifier 30 Resources
instantiates-canonical reference Instantiates FHIR protocol or definition NutritionOrder.instantiatesCanonical ( PlanDefinition , ActivityDefinition identifier ) instantiates-uri uri token Instantiates Return nutrition orders with this external protocol or definition identifier NutritionOrder.instantiatesUri NutritionOrder.identifier 65 Resources
oraldiet token Type of diet that can be consumed orally (i.e., take via the mouth). NutritionOrder.oralDiet.type
patient reference The identity of the person individual or set of individuals who requires the diet, formula or nutritional supplement NutritionOrder.patient NutritionOrder.subject.where(resolve() is Patient)
( Patient ) 		33 66 Resources
provider reference The identity of the provider who placed the nutrition order NutritionOrder.orderer
( Practitioner , PractitionerRole )
status token Status of the nutrition order. NutritionOrder.status
subject reference The identity of the individual or set of individuals who requires the diet, formula or nutritional supplement NutritionOrder.subject
( Group , Patient )
supplement token Type of supplement product requested NutritionOrder.supplement.type NutritionOrder.supplement.type.concept