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Orders and Observations icon Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Encounter, Patient, Practitioner

Detailed Descriptions for the elements in the NutritionOrder resource.

NutritionOrder
Element IdNutritionOrder
Definition

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

Short DisplayDiet, formula or nutritional supplement request
Cardinality0..*
TypeDomainResource
Alternate NamesNutrition Order; Diet Order; Diet; Nutritional Supplement; Enteral Nutrition
Summaryfalse
Comments

Referenced by an Order Request (workflow).

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

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

Short DisplayIdentifiers assigned to this order
NoteThis is a business identifier, not a resource identifier (see discussion)
Cardinality0..*
TypeIdentifier
Summaryfalse
Comments

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

NutritionOrder.instantiatesCanonical
Element IdNutritionOrder.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.

Short DisplayInstantiates FHIR protocol or definition
Cardinality0..*
Typecanonical(ActivityDefinition | PlanDefinition)
Summarytrue
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 IdNutritionOrder.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.

Short DisplayInstantiates external protocol or definition
Cardinality0..*
Typeuri
Summarytrue
Comments

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

NutritionOrder.instantiates
Element IdNutritionOrder.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.

Short DisplayInstantiates protocol or definition
Cardinality0..*
Typeuri
Summaryfalse
NutritionOrder.basedOn
Element IdNutritionOrder.basedOn
Definition

A plan or request that is fulfilled in whole or in part by this nutrition order.

Short DisplayWhat this order fulfills
Cardinality0..*
TypeReference(CarePlan | NutritionOrder | ServiceRequest)
Summaryfalse
NutritionOrder.status
Element IdNutritionOrder.status
Definition

The workflow status of the nutrition order/request.

Short Displaydraft | active | on-hold | revoked | completed | entered-in-error | unknown
Cardinality1..1
Terminology BindingRequestStatus (Required)
Typecode
Is Modifiertrue (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)
Summarytrue
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 IdNutritionOrder.intent
Definition

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

Short Displayproposal | plan | directive | order | original-order | reflex-order | filler-order | instance-order | option
Cardinality1..1
Terminology BindingRequestIntent (Required)
Typecode
Is Modifiertrue (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 Namescategory
Summarytrue
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.priority
Element IdNutritionOrder.priority
Definition

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

Short Displayroutine | urgent | asap | stat
Cardinality0..1
Terminology BindingRequestPriority (Required)
Typecode
Summaryfalse
NutritionOrder.subject
Element IdNutritionOrder.subject
Definition

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

Short DisplayWho requires the diet, formula or nutritional supplement
Cardinality1..1
TypeReference(Patient | Group)
Summarytrue
NutritionOrder.encounter
Element IdNutritionOrder.encounter
Definition

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

Short DisplayThe encounter associated with this nutrition order
Cardinality0..1
TypeReference(Encounter)
Summaryfalse
NutritionOrder.supportingInformation
Element IdNutritionOrder.supportingInformation
Definition

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

Short DisplayInformation to support fulfilling of the nutrition order
Cardinality0..*
TypeReference(Any)
Summaryfalse
NutritionOrder.dateTime
Element IdNutritionOrder.dateTime
Definition

The date and time that this nutrition order was requested.

Short DisplayDate and time the nutrition order was requested
Cardinality1..1
TypedateTime
Summarytrue
NutritionOrder.orderer
Element IdNutritionOrder.orderer
Definition

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

Short DisplayWho ordered the diet, formula or nutritional supplement
Cardinality0..1
TypeReference(Practitioner | PractitionerRole)
Summarytrue
NutritionOrder.performer
Element IdNutritionOrder.performer
Definition

The specified desired performer of the nutrition order.

Short DisplayWho is desired to perform the administration of what is being ordered
Cardinality0..*
TypeCodeableReference(CareTeam | Practitioner | PractitionerRole | RelatedPerson | Patient | Organization)
Summaryfalse
NutritionOrder.allergyIntolerance
Element IdNutritionOrder.allergyIntolerance
Definition

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

Short DisplayList of the patient's food and nutrition-related allergies and intolerances
Cardinality0..*
TypeReference(AllergyIntolerance)
Summaryfalse
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 IdNutritionOrder.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.

Short DisplayOrder-specific modifier about the type of food that should be given
Cardinality0..*
Terminology BindingDiet (Example)
TypeCodeableConcept
Summaryfalse
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 IdNutritionOrder.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 diet for any reason. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedings.

Short DisplayOrder-specific modifier about the type of food that should not be given
Cardinality0..*
Terminology BindingFood Type Codes (Example)
TypeCodeableConcept
Summaryfalse
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.outsideFoodAllowed
Element IdNutritionOrder.outsideFoodAllowed
Definition

This modifier is used to convey whether a food item is allowed to be brought in by the patient and/or family. If set to true, indicates that the receiving system does not need to supply the food item.

Short DisplayCapture when a food item is brought in by the patient and/or family
Cardinality0..1
Typeboolean
Summaryfalse
NutritionOrder.oralDiet
Element IdNutritionOrder.oralDiet
Definition

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

Short DisplayOral diet components
Cardinality0..1
Summaryfalse
Invariants
Affect this element
nor-1Warning Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula classoralDiet.exists() or supplement.exists() or enteralFormula.exists()
NutritionOrder.oralDiet.type
Element IdNutritionOrder.oralDiet.type
Definition

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

Short DisplayType of oral diet or diet restrictions that describe what can be consumed orally
Cardinality0..*
Terminology BindingDiet Codes (Example)
TypeCodeableConcept
Summarytrue
NutritionOrder.oralDiet.schedule
Element IdNutritionOrder.oralDiet.schedule
Definition

Schedule information for an oral diet.

Short DisplayScheduling information for oral diets
Cardinality0..1
Summaryfalse
NutritionOrder.oralDiet.schedule.timing
Element IdNutritionOrder.oralDiet.schedule.timing
Definition

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

Short DisplayScheduled frequency of diet
Cardinality0..*
TypeTiming
Alternate NamesFrequency
Summaryfalse
NutritionOrder.oralDiet.schedule.asNeeded
Element IdNutritionOrder.oralDiet.schedule.asNeeded
Definition

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

Short DisplayTake 'as needed'
Cardinality0..1
Typeboolean
Summaryfalse
NutritionOrder.oralDiet.schedule.asNeededFor
Element IdNutritionOrder.oralDiet.schedule.asNeededFor
Definition

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

Short DisplayTake 'as needed' for x
Cardinality0..1
Terminology BindingSNOMED CT Medication As Needed Reason Codes (Example)
TypeCodeableConcept
Summaryfalse
NutritionOrder.oralDiet.nutrient
Element IdNutritionOrder.oralDiet.nutrient
Definition

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

Short DisplayRequired nutrient modifications
Cardinality0..*
Summaryfalse
NutritionOrder.oralDiet.nutrient.modifier
Element IdNutritionOrder.oralDiet.nutrient.modifier
Definition

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

Short DisplayType of nutrient that is being modified
Cardinality0..1
Terminology BindingNutrient Modifier Codes (Example)
TypeCodeableConcept
Summaryfalse
NutritionOrder.oralDiet.nutrient.amount
Element IdNutritionOrder.oralDiet.nutrient.amount
Definition

The quantity of the specified nutrient to include in diet.

Short DisplayQuantity of the specified nutrient
Cardinality0..1
TypeSimpleQuantity
Summaryfalse
NutritionOrder.oralDiet.texture
Element IdNutritionOrder.oralDiet.texture
Definition

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

Short DisplayRequired texture modifications
Cardinality0..*
Summaryfalse
NutritionOrder.oralDiet.texture.modifier
Element IdNutritionOrder.oralDiet.texture.modifier
Definition

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

Short DisplayCode to indicate how to alter the texture of the foods, e.g. pureed
Cardinality0..1
Terminology BindingTexture Modifier Codes (Example)
TypeCodeableConcept
Summaryfalse
Comments

Coupled with the foodType (Meat).

NutritionOrder.oralDiet.texture.foodType
Element IdNutritionOrder.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.

Short DisplayConcepts that are used to identify an entity that is ingested for nutritional purposes
Cardinality0..1
Terminology BindingTexture Modified Food Type Codes (Example)
TypeCodeableConcept
Summaryfalse
Comments

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

NutritionOrder.oralDiet.fluidConsistencyType
Element IdNutritionOrder.oralDiet.fluidConsistencyType
Definition

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

Short DisplayThe required consistency of fluids and liquids provided to the patient
Cardinality0..*
Terminology BindingFluid Consistency Type Codes (Example)
TypeCodeableConcept
Summaryfalse
NutritionOrder.oralDiet.instruction
Element IdNutritionOrder.oralDiet.instruction
Definition

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

Short DisplayInstructions or additional information about the oral diet
Cardinality0..1
Typestring
Summarytrue
Comments

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

NutritionOrder.supplement
Element IdNutritionOrder.supplement
Definition

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

Short DisplaySupplement components
Cardinality0..*
Summaryfalse
Invariants
Affect this element
nor-1Warning Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula classoralDiet.exists() or supplement.exists() or enteralFormula.exists()
NutritionOrder.supplement.type
Element IdNutritionOrder.supplement.type
Definition

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

Short DisplayType of supplement product requested
Cardinality0..1
Terminology BindingSupplement Type Codes (Example)
TypeCodeableReference(NutritionProduct)
Summarytrue
NutritionOrder.supplement.productName
Element IdNutritionOrder.supplement.productName
Definition

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

Short DisplayProduct or brand name of the nutritional supplement
Cardinality0..1
Typestring
Summaryfalse
NutritionOrder.supplement.schedule
Element IdNutritionOrder.supplement.schedule
Definition

Schedule information for a supplement.

Short DisplayScheduling information for supplements
Cardinality0..1
Summaryfalse
NutritionOrder.supplement.schedule.timing
Element IdNutritionOrder.supplement.schedule.timing
Definition

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

Short DisplayScheduled frequency of diet
Cardinality0..*
TypeTiming
Alternate NamesFrequency
Summaryfalse
NutritionOrder.supplement.schedule.asNeeded
Element IdNutritionOrder.supplement.schedule.asNeeded
Definition

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

Short DisplayTake 'as needed'
Cardinality0..1
Typeboolean
Summaryfalse
NutritionOrder.supplement.schedule.asNeededFor
Element IdNutritionOrder.supplement.schedule.asNeededFor
Definition

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

Short DisplayTake 'as needed' for x
Cardinality0..1
Terminology BindingSNOMED CT Medication As Needed Reason Codes (Example)
TypeCodeableConcept
Summaryfalse
NutritionOrder.supplement.quantity
Element IdNutritionOrder.supplement.quantity
Definition

The amount of the nutritional supplement to be given.

Short DisplayAmount of the nutritional supplement
Cardinality0..1
TypeSimpleQuantity
Summaryfalse
NutritionOrder.supplement.instruction
Element IdNutritionOrder.supplement.instruction
Definition

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

Short DisplayInstructions or additional information about the oral supplement
Cardinality0..1
Typestring
Summarytrue
Comments

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

NutritionOrder.enteralFormula
Element IdNutritionOrder.enteralFormula
Definition

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

Short DisplayEnteral formula components
Cardinality0..1
Summaryfalse
Invariants
Affect this element
nor-1Warning Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula classoralDiet.exists() or supplement.exists() or enteralFormula.exists()
NutritionOrder.enteralFormula.baseFormulaType
Element IdNutritionOrder.enteralFormula.baseFormulaType
Definition

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

Short DisplayType of enteral or infant formula
Cardinality0..1
Terminology BindingEnteral Formula Type Codes (Example)
TypeCodeableReference(NutritionProduct)
Summarytrue
NutritionOrder.enteralFormula.baseFormulaProductName
Element IdNutritionOrder.enteralFormula.baseFormulaProductName
Definition

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

Short DisplayProduct or brand name of the enteral or infant formula
Cardinality0..1
Typestring
Summaryfalse
NutritionOrder.enteralFormula.deliveryDevice
Element IdNutritionOrder.enteralFormula.deliveryDevice
Definition

The intended type of device that is to be used for the administration of the enteral formula.

Short DisplayIntended type of device for the administration
Cardinality0..*
TypeCodeableReference(DeviceDefinition)
Summaryfalse
NutritionOrder.enteralFormula.additive
Element IdNutritionOrder.enteralFormula.additive
Definition

Indicates modular components to be provided in addition or mixed with the base formula.

Short DisplayComponents to add to the feeding
Cardinality0..*
Summaryfalse
Invariants
Affect this element
nor-1Warning Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula classoralDiet.exists() or supplement.exists() or enteralFormula.exists()
NutritionOrder.enteralFormula.additive.type
Element IdNutritionOrder.enteralFormula.additive.type
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.

Short DisplayType of modular component to add to the feeding
Cardinality0..1
Terminology BindingEnteral Formula Additive Type Code (Example)
TypeCodeableReference(NutritionProduct)
Summaryfalse
NutritionOrder.enteralFormula.additive.productName
Element IdNutritionOrder.enteralFormula.additive.productName
Definition

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

Short DisplayProduct or brand name of the modular additive
Cardinality0..1
Typestring
Summaryfalse
NutritionOrder.enteralFormula.additive.quantity
Element IdNutritionOrder.enteralFormula.additive.quantity
Definition

The amount of additive to be given in addition or to be mixed in with the base formula.

Short DisplayAmount of additive to be given or mixed in
Cardinality0..1
TypeSimpleQuantity
Summaryfalse
NutritionOrder.enteralFormula.caloricDensity
Element IdNutritionOrder.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.

Short DisplayAmount of energy per specified volume that is required
Cardinality0..1
TypeSimpleQuantity
Summaryfalse
NutritionOrder.enteralFormula.routeOfAdministration
Element IdNutritionOrder.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.

Short DisplayHow the formula should enter the patient's gastrointestinal tract
Cardinality0..1
Terminology BindingEnteral Route Codes (Extensible)
TypeCodeableConcept
Summaryfalse
NutritionOrder.enteralFormula.administration
Element IdNutritionOrder.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.

Short DisplayFormula feeding instruction as structured data
Cardinality0..*
Summaryfalse
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 IdNutritionOrder.enteralFormula.administration.schedule
Definition

Schedule information for an enteral formula.

Short DisplayScheduling information for enteral formula products
Cardinality0..1
Summaryfalse
NutritionOrder.enteralFormula.administration.schedule.timing
Element IdNutritionOrder.enteralFormula.administration.schedule.timing
Definition

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.

Short DisplayScheduled frequency of enteral formula
Cardinality0..*
TypeTiming
Alternate NamesFrequency
Summaryfalse
NutritionOrder.enteralFormula.administration.schedule.asNeeded
Element IdNutritionOrder.enteralFormula.administration.schedule.asNeeded
Definition

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

Short DisplayTake 'as needed'
Cardinality0..1
Typeboolean
Summaryfalse
NutritionOrder.enteralFormula.administration.schedule.asNeededFor
Element IdNutritionOrder.enteralFormula.administration.schedule.asNeededFor
Definition

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

Short DisplayTake 'as needed' for x
Cardinality0..1
Terminology BindingSNOMED CT Medication As Needed Reason Codes (Example)
TypeCodeableConcept
Summaryfalse
NutritionOrder.enteralFormula.administration.quantity
Element IdNutritionOrder.enteralFormula.administration.quantity
Definition

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

Short DisplayThe volume of formula to provide
Cardinality0..1
TypeSimpleQuantity
Summaryfalse
NutritionOrder.enteralFormula.administration.rate[x]
Element IdNutritionOrder.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.

Short DisplaySpeed with which the formula is provided per period of time
Cardinality0..1
TypeSimpleQuantity|Ratio
[x] NoteSee Choice of Datatypes for further information about how to use [x]
Summaryfalse
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 IdNutritionOrder.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.

Short DisplayUpper limit on formula volume per unit of time
Cardinality0..1
TypeSimpleQuantity
Summaryfalse
NutritionOrder.enteralFormula.administrationInstruction
Element IdNutritionOrder.enteralFormula.administrationInstruction
Definition

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

Short DisplayFormula feeding instructions expressed as text
Cardinality0..1
Typestring
Summarytrue
Comments

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

NutritionOrder.note
Element IdNutritionOrder.note
Definition

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

Short DisplayComments
Cardinality0..*
TypeAnnotation
Summaryfalse
Comments

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