Generated Narrative: StructureDefinition profile-nutritionorder Name Flags Card. Type Description & Constraints NutritionOrder NutritionOrder #xD; contained S 0..* Resource Contained, inline Resources #xD; Slices for extension 0..* Extension Extension Slice: Unordered, Open by value:url, value:value #xD; extension:Coverage-Information S 0..* (Complex) Coverage Info URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information #xD; extension:EncounterCategory S 0..1 (Complex) Encounter Category URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-request-category #xD; value[x] 0..1 CodeableConcept Value of extension Binding: ActEncounterCode (3.0.0) (required) #xD; extension:ServiceCategory S 0..1 (Complex) Service Category URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-request-category #xD; value[x] 0..1 CodeableConcept Value of extension Binding: X12 Service Type (required) #xD; identifier S 0..* Identifier Identifiers assigned to this order #xD; status S 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown Example General: draft #xD; patient S 1..1 Reference(CRD Patient) The person who requires the diet, formula or nutritional supplement #xD; encounter S 0..1 Reference(CRD Encounter) The encounter associated with this nutrition order #xD; dateTime S 1..1 dateTime Date and time the nutrition order was requested #xD; orderer S 1..1 Reference(CRD Practitioner S | HRex PractitionerRole Profile S) Who ordered the diet, formula or nutritional supplement #xD; allergyIntolerance S 0..* Reference(US Core AllergyIntolerance Profile(7.0.0)) List of the patient's food and nutrition-related allergies and intolerances #xD; foodPreferenceModifier S 0..* CodeableConcept Order-specific modifier about the type of food that should be given Binding: Types of Edible Substances (extensible) #xD; excludeFoodModifier S 0..* CodeableConcept Order-specific modifier about the type of food that should not be given Binding: Types of Edible Substances (extensible) #xD; oralDiet S 0..1 BackboneElement Oral diet components #xD; type S 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally Binding: Diet Codes (extensible) #xD; schedule S 0..* CRDTiming Scheduled frequency of diet #xD; nutrient S 0..* BackboneElement Required nutrient modifications #xD; modifier S 0..1 CodeableConcept Type of nutrient that is being modified Binding: Nutrient Codes (extensible) #xD; texture S 0..* BackboneElement Required texture modifications #xD; modifier S 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g. pureed Binding: TextureModifierCodes (extensible) #xD; foodType S 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes Binding: TextureModifiedFoodTypeCodes (extensible) #xD; supplement S 0..* BackboneElement Supplement components #xD; type S 0..1 CodeableConcept Type of supplement product requested Binding: SupplementTypeCodes (extensible) #xD; schedule S 0..* CRDTiming Scheduled frequency of supplement #xD; quantity S 0..1 SimpleQuantity(4.0.1) Amount of the nutritional supplement #xD; enteralFormula S 0..1 BackboneElement Enteral formula components #xD; baseFormulaType S 0..1 CodeableConcept Type of enteral or infant formula Binding: EnteralFormulaTypeCodes (extensible) #xD; additiveType S 0..1 CodeableConcept Type of modular component to add to the feeding Binding: EnteralFormulaAdditiveTypeCode (extensible) #xD; caloricDensity S 0..1 SimpleQuantity(4.0.1) Amount of energy per specified volume that is required #xD; routeofAdministration S 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract Binding: EnteralRouteCodes (extensible) #xD; administration S 0..* BackboneElement Formula feeding instruction as structured data #xD; schedule S 0..1 CRDTiming Scheduled frequency of enteral feeding #xD; quantity S 0..1 SimpleQuantity(4.0.1) The volume of formula to provide #xD; Slices for rate[x] 0..1 SimpleQuantity(4.0.1), Ratio Speed with which the formula is provided per period of time Slice: Unordered, Open by type:$this #xD; rate[x]:rateRatio S 0..1 Ratio Speed with which the formula is provided per period of time #xD; Documentation for this format
HL7 International / Financial Management
This profile specifies extensions and constraints on the NutritionOrder resource to support coverage requirements discovery.
Diet, formula or nutritional supplement request
A request to supply a diet, formula feeding (enteral) or oral nutritional supplement to a patient/resident.
Referenced by an Order Request (workflow).
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class
oralDiet.exists() or supplement.exists() or enteralFormula.exists()
exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula)
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Any references found in this resource, with the exception of 'Patient' could potentially be resource-specific and thus transmitted as contained resources.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Questionnaire is only allowed when doc-needed exists
extension.where(url='questionnaire').exists() implies extension.where(url = 'doc-needed').exists()
If covered is set to 'not-covered', then 'pa-needed' must not exist.
extension.where(url = 'covered' and value = 'not-covered').exists() implies extension.where(url = 'pa-needed').exists().not()
'info-needed' SHALL exist if and only if at least one of 'covered', 'pa-needed', or 'doc-needed' is set to 'conditional'.
extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1 implies extension.where(url = 'info-needed').exists()
If 'pa-needed' is 'satisfied', 'noauth', or 'not-covered', then 'Doc-purpose' cannot be 'withpa'.
extension.where(url = 'pa-needed' and (value = 'satisfied' or value = 'noauth' or value = 'not-covered')) and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'withpa')
'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()
If 'info-needed' is OTH, then reason must be specified
extension.where(url = 'info-needed' and value = 'OTH').exists() implies extension.where(url = 'reason').exists()
If reason.coding is present and is not from the extensible value set, then reason.text must be present
extension.where(url = 'reason').empty() or extension.where(url = 'reason').value.text.exists() or extension.where(url = 'reason').value.memberOf('http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons')
If doc-purpose is present with a value other than 'conditional', then reason must be present
extension.where(url = 'doc-purpose' and value != 'conditional').exists() implies extension.where(url = 'reason').exists()
A high-level categorization of the type of request
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Source of the definition for the extension code - a logical name or a URL.
The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/R4/extensibility.html) for a list).
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Identifiers assigned to this order by the order sender or by the order receiver.
The Identifier.type element can be to indicate filler vs. placer if needed. This is explained in further detail [here](http://hl7.org/fhir/R4/servicerequest.html#notes).
Instantiates FHIR protocol or 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.
Note: This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). 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.
Instantiates external protocol or 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.
This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
The URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder.
draft | active | on-hold | revoked | completed | entered-in-error | unknown
The workflow status of the nutrition order/request.
This will be 'draft' when using order-select or an initial order-sign, but may be 'active' or other values for order-sign representing edits to the order or for order-dispatch.
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
Codes identifying the lifecycle stage of the nutrition order.
proposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Indicates the level of authority/intentionality associated with the NutrionOrder and where the request fits into the workflow chain.
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.
Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.
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
Codes indicating the degree of authority/intentionality associated with a nutrition order.
.moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
The person who requires the diet, formula or nutritional supplement
The person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feeding.
The encounter associated with this nutrition order
An encounter that provides additional information about the healthcare context in which this request is made.
potentially relevant for CRD in some situations.
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Date and time the nutrition order was requested
The date and time that this nutrition order was requested.
Who ordered the diet, formula or nutritional supplement
The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedings.
List of the patient's food and nutrition-related allergies and intolerances
A link to a record of allergies or intolerances which should be included in the nutrition order.
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.
.outboundRelationship[typeCode=RSON].target[classCode=OBS, moodCode=EVN]
Order-specific modifier about the type of food that should be given
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.
Information on a patient's food preferences that inform healthcare personnel about the food that the patient should receive or consume.
.outboundRelationship [typeCode =COMP], target [classCode=PROC, moodCode=EVN, code=NutritionModificationType]
Order-specific modifier about the type of food that should not be given
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.
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.
Diet given orally in contrast to enteral (tube) feeding.
oralDiet .outboundRelationship [typeCode =COMP], target [classCode=SPLY, moodCode=RQO, code=OralDietSupplyType]
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Type of oral diet or diet restrictions that describe what can be consumed orally
The kind of diet or dietary restriction such as fiber restricted diet or diabetic diet.
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.
Class that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet.
.participation[typeCode=PRD].role[classCode=MANU], manufacturedFoodKind
The nutrient that is being modified such as carbohydrate or sodium.
The quantity of the specified nutrient to include in diet.
Class that describes any texture modifications required for the patient to safely consume various types of solid foods.
.inboundRelationship [typeCode =COMP], target [classCode=PROC, moodCode=EVN, code=DietTextureModificationType]
Code to indicate how to alter the texture of the foods, e.g. pureed
Any texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureed.
Concepts that are used to identify an entity that is ingested for nutritional purposes
The food type(s) (e.g. meats, all foods) that the texture modification applies to. This could be all foods types.
Coupled with the `texture.modifier`; could be (All Foods).
.participation[typeCode=PRD].role[classCode=MANU], manufacturedFoodKind; .code
The required consistency of fluids and liquids provided to the patient
The required consistency (e.g. honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patient.
Codes used to represent the consistency of fluids and liquids provided to the patient.
.code (Not differentiated from dietTextureModificationType in HL7 v3)
Instructions or additional information about the oral diet
Free text or additional instructions or information pertaining to the oral diet.
Free text dosage instructions can be used for cases where the instructions are too complex to code.
Oral nutritional products given in order to add further nutritional value to the patient's diet.
.outboundRelationship [typeCode =COMP], target [classCode=SPLY, moodCode=RQO, code=SUPPLEMENT]
The kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplement.
.participation[typeCode=PRD].role[classCode=MANU], manufacturedFoodKind; .code (NutritionalSupplementType)
Product or brand name of the nutritional supplement
The product or brand name of the nutritional supplement such as "Acme Protein Shake".
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.
The amount of the nutritional supplement to be given.
Instructions or additional information about the oral supplement
Free text or additional instructions or information pertaining to the oral supplement.
Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavity.
.outboundRelationship [typeCode =COMP], target [classCode=SPLY, moodCode=RQO, code=FORMULA]
The type of enteral or infant formula such as an adult standard formula with fiber or a soy-based infant formula.
.participation[typeCode=PRD].role[classCode=MANU], manufacturedFoodKind; .code (NutritionalFormulaType)
Product or brand name of the enteral or infant formula
The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula".
Type of modular component to add to the feeding
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.
N/A (not differentiated from NutritionalFormulaType in HL7 v3)
Product or brand name of the modular additive
The product or brand name of the type of modular component to be added to the formula.
Amount of energy per specified volume that is required
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.
How the formula should enter the patient's gastrointestinal tract
The route or physiological path of administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tube.
Formula feeding instruction as structured data
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.
See implementation notes below for further discussion on how to order continuous vs bolus enteral feeding using this resource.
.outboundRelationship [typeCode =COMP], target [classCode=SBADM, moodCode=RQO]
The time period and frequency at which the enteral formula should be delivered to the patient.
The volume of formula to provide to the patient per the specified administration schedule.
Speed with which the formula is provided per period of time
The rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedule.
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".
Upper limit on formula volume per unit of time
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.
Formula feeding instructions expressed as text
Free text formula administration, feeding instructions or additional instructions or information.
Comments made about the {{title}} by the requester, performer, subject or other participants.
This element SHALL NOT be used to supply free text instructions for the diet which are represented in the `.oralDiet.instruction`, `supplement.instruction`, or `enteralFormula.administrationInstruction` elements.