R4 Ballot #1 (Mixed Normative/Trial use) Current Build
This page was published as part of FHIR v3.3.0: R4 Ballot #1 : Mixed Normative/Trial use (First Normative ballot). It has been superceded by R4 . For a full list of available versions, see the Directory of published versions .
Orders and Observations Work Group Maturity Level : 2   Trial Use Security Category : Patient Compartments : Encounter , Patient , Practitioner

Detailed Descriptions for the elements in the NutritionOrder resource.

NutritionOrder
Element Id NutritionOrder
Definition

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

Control Cardinality 1..1 0..*
Type DomainResource
Alternate Names Nutrition Order; Diet Order; Diet; Nutritional Supplement; Enteral Nutrition
Comments

Referenced by an Order Request (workflow).

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

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

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

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

NutritionOrder.instantiatesCanonical
Element Id NutritionOrder.instantiatesCanonical
Definition

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.

Cardinality 0..*
Type canonical ( ActivityDefinition | PlanDefinition )
Summary true
Comments

Note: This is a business identifier, not a resource identifier (see discussion ). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

NutritionOrder.instantiatesUri
Element Id NutritionOrder.instantiatesUri
Definition

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.

Cardinality 0..*
Type uri
Summary true
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

NutritionOrder.instantiates
Element Id NutritionOrder.instantiates
Definition

The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder.

Control Cardinality 0..*
Type uri
NutritionOrder.status
Element Id NutritionOrder.status
Definition

The workflow status of the nutrition order/request.

Control Cardinality 1..1
Terminology Binding RequestStatus ( Required )
Type code
Is Modifier true (Reason: This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid)
Summary true
Comments

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

NutritionOrder.intent
Element Id NutritionOrder.intent
Definition

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

Control Cardinality 1..1
Terminology Binding RequestIntent ( Required )
Type code
Is Modifier true (Reason: This element changes the interpretation of all descriptive attributes. For example "the time the request is recommended to occur" vs. "the time the request is authorized to occur" or "who is recommended to perform the request" vs. "who is authorized to perform the request)
Requirements

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

Alternate Names category
Summary true
Comments

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

NutritionOrder.patient
Element Id NutritionOrder.patient
Definition

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

Control Cardinality 1..1
Type Reference ( Patient )
Summary true
NutritionOrder.context NutritionOrder.encounter
Element Id NutritionOrder.context NutritionOrder.encounter
Definition

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

Control Cardinality 0..1
Type Reference ( Encounter | EpisodeOfCare )
NutritionOrder.dateTime
Element Id NutritionOrder.dateTime
Definition

The date and time that this nutrition order was requested.

Control Cardinality 1..1
Type dateTime
Summary true
NutritionOrder.orderer
Element Id NutritionOrder.orderer
Definition

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

Control Cardinality 0..1
Type Reference ( Practitioner | PractitionerRole )
Patterns Reference(Practitioner,PractitionerRole): Common patterns = Participant
Summary true
NutritionOrder.allergyIntolerance
Element Id NutritionOrder.allergyIntolerance
Definition

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

Control Cardinality 0..*
Type Reference ( AllergyIntolerance )
Comments

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

NutritionOrder.foodPreferenceModifier
Element Id NutritionOrder.foodPreferenceModifier
Definition

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

Control Cardinality 0..*
Terminology Binding Diet ( Example )
Type CodeableConcept
Comments

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

NutritionOrder.excludeFoodModifier
Element Id NutritionOrder.excludeFoodModifier
Definition

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 patient’s diet for any reason. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.

Control Cardinality 0..*
Terminology Binding Food Type Codes ( Example )
Type CodeableConcept
Comments

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

NutritionOrder.oralDiet
Element Id NutritionOrder.oralDiet
Definition

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

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

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

Control Cardinality 0..*
Terminology Binding Diet Codes ( Example )
Type CodeableConcept
Summary true
NutritionOrder.oralDiet.schedule
Element Id NutritionOrder.oralDiet.schedule
Definition

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

Control Cardinality 0..*
Type Timing
Alternate Names Frequency
NutritionOrder.oralDiet.nutrient
Element Id NutritionOrder.oralDiet.nutrient
Definition

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

Control Cardinality 0..*
NutritionOrder.oralDiet.nutrient.modifier
Element Id NutritionOrder.oralDiet.nutrient.modifier
Definition

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

Control Cardinality 0..1
Terminology Binding Nutrient Modifier Codes ( Example )
Type CodeableConcept
NutritionOrder.oralDiet.nutrient.amount
Element Id NutritionOrder.oralDiet.nutrient.amount
Definition

The quantity of the specified nutrient to include in diet.

Control Cardinality 0..1
Type SimpleQuantity
NutritionOrder.oralDiet.texture
Element Id NutritionOrder.oralDiet.texture
Definition

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

Control Cardinality 0..*
NutritionOrder.oralDiet.texture.modifier
Element Id NutritionOrder.oralDiet.texture.modifier
Definition

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

Control Cardinality 0..1
Terminology Binding Texture Modifier Codes ( Example )
Type CodeableConcept
Comments

Coupled with the foodType (Meat).

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

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

Control Cardinality 0..1
Terminology Binding Texture Modified Food Type Codes ( Example )
Type CodeableConcept
Comments

Coupled with the texture.modifier ; could be (All Foods).

NutritionOrder.oralDiet.fluidConsistencyType
Element Id NutritionOrder.oralDiet.fluidConsistencyType
Definition

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

Control Cardinality 0..*
Terminology Binding Fluid Consistency Type Codes ( Example )
Type CodeableConcept
NutritionOrder.oralDiet.instruction
Element Id NutritionOrder.oralDiet.instruction
Definition

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

Control Cardinality 0..1
Type string
Summary true
Comments

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

NutritionOrder.supplement
Element Id NutritionOrder.supplement
Definition

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

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

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

Control Cardinality 0..1
Terminology Binding Supplement Type Codes ( Example )
Type CodeableConcept
Summary true
NutritionOrder.supplement.productName
Element Id NutritionOrder.supplement.productName
Definition

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

Control Cardinality 0..1
Type string
NutritionOrder.supplement.schedule
Element Id NutritionOrder.supplement.schedule
Definition

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

Control Cardinality 0..*
Type Timing
Alternate Names Frequency
NutritionOrder.supplement.quantity
Element Id NutritionOrder.supplement.quantity
Definition

The amount of the nutritional supplement to be given.

Control Cardinality 0..1
Type SimpleQuantity
NutritionOrder.supplement.instruction
Element Id NutritionOrder.supplement.instruction
Definition

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

Control Cardinality 0..1
Type string
Summary true
Comments

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

NutritionOrder.enteralFormula
Element Id NutritionOrder.enteralFormula
Definition

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

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

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

Control Cardinality 0..1
Terminology Binding Enteral Formula Type Codes ( Example )
Type CodeableConcept
Summary true
NutritionOrder.enteralFormula.baseFormulaProductName
Element Id NutritionOrder.enteralFormula.baseFormulaProductName
Definition

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

Control Cardinality 0..1
Type string
NutritionOrder.enteralFormula.additiveType
Element Id NutritionOrder.enteralFormula.additiveType
Definition

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

Control Cardinality 0..1
Terminology Binding Enteral Formula Additive Type Code ( Example )
Type CodeableConcept
NutritionOrder.enteralFormula.additiveProductName
Element Id NutritionOrder.enteralFormula.additiveProductName
Definition

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

Control Cardinality 0..1
Type string
NutritionOrder.enteralFormula.caloricDensity
Element Id NutritionOrder.enteralFormula.caloricDensity
Definition

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

Control Cardinality 0..1
Type SimpleQuantity
NutritionOrder.enteralFormula.routeofAdministration
Element Id NutritionOrder.enteralFormula.routeofAdministration
Definition

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

Control Cardinality 0..1
Terminology Binding Enteral Route Codes ( Extensible )
Type CodeableConcept
NutritionOrder.enteralFormula.administration
Element Id NutritionOrder.enteralFormula.administration
Definition

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.

Control Cardinality 0..*
Comments

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

NutritionOrder.enteralFormula.administration.schedule
Element Id NutritionOrder.enteralFormula.administration.schedule
Definition

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

Control Cardinality 0..1
Type Timing
Alternate Names Frequency
NutritionOrder.enteralFormula.administration.quantity
Element Id NutritionOrder.enteralFormula.administration.quantity
Definition

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

Control Cardinality 0..1
Type SimpleQuantity
NutritionOrder.enteralFormula.administration.rate[x]
Element Id NutritionOrder.enteralFormula.administration.rate[x]
Definition

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

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

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

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

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.

Control Cardinality 0..1
Type SimpleQuantity
NutritionOrder.enteralFormula.administrationInstruction
Element Id NutritionOrder.enteralFormula.administrationInstruction
Definition

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

Control Cardinality 0..1
Type string
Summary true
Comments

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

NutritionOrder.note
Element Id NutritionOrder.note
Definition

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

Control Cardinality 0..*
Type Annotation
Comments

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