type: resource-definitionsresource: NutritionOrder

NutritionOrder Definitions

NutritionOrder

Diet, formula or nutritional supplement request

Definition: A request to supply a diet, formula feeding (enteral) or oral nutritional supplement to an individual or group.

Comments: Referenced by an Order Request (workflow).

Aliases: Nutrition Order, Diet Order, Diet, Nutritional Supplement, Enteral Nutrition

Cardinality: 0..*

Constraints: nor-1 | error | Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class | oralDiet.exists() or supplement.exists() or enteralFormula.exists()

Mappings: workflow=Request; v2=ORC / ODS; rim=SupplyRequest; w5=clinical.careprovision

NutritionOrder.identifier

Identifiers assigned to this order

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

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

Cardinality: 0..*

Type: Identifier

Mappings: workflow=Request.identifier; w5=FiveWs.identifier; v2=ORC-2/ORC-3; rim=.id

NutritionOrder.basedOn

What this order fulfills

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

Cardinality: 0..*

Type: Reference(CarePlan, NutritionOrder, ServiceRequest, RequestOrchestration)

Mappings: workflow=Request.basedOn

NutritionOrder.groupIdentifier

Composite Request ID

Definition: 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.

Aliases: grouperId, groupIdentifier

Cardinality: 0..1

Type: Identifier

Summary: true

Mappings: workflow=Request.groupIdentifier; v2=ORC-4; rim=.inboundRelationship(typeCode=COMP].source[moodCode=INT].identifier

NutritionOrder.status

Definition: The workflow status of the nutrition order/request.

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.

Cardinality: 1..1

Type: code

Binding: required:request-status

Summary: true

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)

Mappings: workflow=Request.status; w5=FiveWs.status; v2=ORC-1; rim=.statusCode

NutritionOrder.intent

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

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.

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

Aliases: category

Cardinality: 1..1

Type: code

Binding: required:request-intent

Summary: true

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)

Mappings: workflow=Request.intent; w5=FiveWs.class; v2=N/A; rim=.moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)

NutritionOrder.priority

routine | urgent | asap | stat

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

Cardinality: 0..1

Type: code

Binding: required:request-priority|6.0.0

Mappings: workflow=Request.priority; w5=FiveWs.grade; rim=.priorityCode

NutritionOrder.subject

Who requires the diet, formula or nutritional supplement

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

Cardinality: 1..1

Type: Reference(Patient, Group)

Summary: true

Mappings: workflow=Request.subject; w5=FiveWs.subject; v2=PID; rim=.participation[typeCode=SBJ].role

NutritionOrder.encounter

The encounter associated with this nutrition order

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

Cardinality: 0..1

Type: Reference(Encounter)

Mappings: workflow=Request.encounter; w5=FiveWs.context; v2=PV1; rim=.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]

NutritionOrder.supportingInformation

Information to support fulfilling of the nutrition order

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

Cardinality: 0..*

Type: Reference(Resource)

NutritionOrder.dateTime

Date and time the nutrition order was requested

Definition: The date and time that this nutrition order was requested.

Cardinality: 1..1

Type: dateTime

Summary: true

Mappings: workflow=Request.authoredOn; w5=FiveWs.recorded; v2=ORC-9; rim=author.time

NutritionOrder.requester

Who ordered the diet, formula or nutritional supplement

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

Cardinality: 0..1

Type: Reference(Practitioner, PractitionerRole)

Summary: true

Mappings: workflow=Request.requester; w5=FiveWs.author; v2=ORC-12; rim=.participation[typeCode=AUT].role

NutritionOrder.performer

Who is intended to perform the administration of the nutrition order

Definition: The specified desired performer of the nutrition order.

Cardinality: 0..*

Type: CodeableReference

Mappings: workflow=Request.performer

NutritionOrder.allergyIntolerance

List of the patient's food and nutrition-related allergies and intolerances

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

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.

Cardinality: 0..*

Type: Reference(AllergyIntolerance)

Mappings: rim=.outboundRelationship[typeCode=RSON].target[classCode=OBS, moodCode=EVN]

NutritionOrder.foodPreferenceModifier

Order-specific modifier about the type of food that should be given

Definition: This modifier is used to convey order-specific modifiers about the type of food (i.e. solid and/or liquid) 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.

Comments: Information on a patient's preferences that informs the healthcare personnel about what the patient should receive or consume.

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:edible-substance-type

Mappings: v2=ODS-1 Value = "P",ODS-3; rim=.outboundRelationship [typeCode =COMP], target [classCode=PROC, moodCode=EVN, code=NutritionModificationType]

NutritionOrder.excludeFoodModifier

Food that should not be given

Definition: This modifier is used to convey Order-specific modifiers 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 what 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.

Comments: Specific types of oral food (solid/liquid) to avoid.

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:edible-substance-type

Mappings: rim=N/A

NutritionOrder.outsideFoodAllowed

Capture if patient is permitted to consume food from outside of current setting brought by the patient, family, and/or caregiver

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

Cardinality: 0..1

Type: boolean

Mappings: rim=N/A

NutritionOrder.oralDiet

Oral diet components

Definition: Diet given orally that may include texture modification, such as International Dysphagia Diet Standardisation Initiative Framework - Slightly Thick Level 1 drinks and Minced and International Dysphagia Diet Standardisation Initiative Framework - Minced and Moist Level 5 food as well as, for example, Decreased potassium diet (ie, nutrient modification), Halal diet (ie, cultural modification), and/or Low microbial diet (eg, other modification).

Conditions: nor-1

Cardinality: 0..1

Type: BackboneElement

Mappings: v2=ODS-1 Value = "D"; rim=oralDiet .outboundRelationship [typeCode =COMP], target [classCode=SPLY, moodCode=RQO, code=OralDietSupplyType]

NutritionOrder.oralDiet.type

Type of oral diet or diet restrictions that can be consumed orally

Definition: The kind of diet or dietary restriction such as fiber restricted diet or diet for diabetes.

Cardinality: 0..*

Type: CodeableConcept

Binding: preferred:diet-type

Summary: true

Mappings: workflow=Request.code; w5=FiveWs.what[x]; v2=ODS-3; rim=.code

NutritionOrder.oralDiet.schedule

Scheduling information for oral diets

Definition: Schedule information for an oral diet.

Cardinality: 0..1

Type: BackboneElement

NutritionOrder.oralDiet.schedule.timing

Scheduled frequency of diet

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.

Aliases: Frequency

Cardinality: 0..*

Type: Timing

Mappings: workflow=Request.occurrence[x]; v2=ODS-2, TQ1-7/8; rim=.expectedUseTime

NutritionOrder.oralDiet.schedule.asNeeded

Take 'as needed'

Definition: Indicates whether the diet is only taken when needed within a specific administration schedule.

Cardinality: 0..1

Type: boolean

NutritionOrder.oralDiet.schedule.asNeededFor

Take 'as needed' for x

Definition: Indicates whether the diet is only taken based on a precondition for taking the diet.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:medication-as-needed-reason

NutritionOrder.oralDiet.nutrient

The nutrient that is modified and the quantity in the diet

Definition: Defines the quantity and the nutrient modified (for example carbohydrate, fiber or sodium) in the oral diet.

Cardinality: 0..*

Type: BackboneElement

Mappings: v2=ODS-4; rim=.participation[typeCode=PRD].role[classCode=MANU], manufacturedFoodKind

NutritionOrder.oralDiet.nutrient.modifier

Nutrient modified in the oral diet type

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

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:nutrient-code

Mappings: workflow=Request.code; w5=FiveWs.what[x]; v2=ODS-4; rim=.code

NutritionOrder.oralDiet.nutrient.amount

Quantity of the specified nutrient

Definition: The quantity of the specified nutrient to include in diet.

Cardinality: 0..1

Type: Quantity

Mappings: v2=ODS-4; rim=.quantity

NutritionOrder.oralDiet.texture

Texture modifications in addition to the oral diet type

Definition: Class that describes any texture modifications in addition to the oral diet type required for the patient to safely consume various types of foods (i.e. solid and/or liquid).

Cardinality: 0..*

Type: BackboneElement

Mappings: v2=ODS-4; rim=.inboundRelationship [typeCode =COMP], target [classCode=PROC, moodCode=EVN, code=DietTextureModificationType]

NutritionOrder.oralDiet.texture.modifier

Food (i.e. solid and/or liquid) texture modifications in addition to those in the oral diet type

Definition: Texture modifications in the addition to the oral diet type that should be made, e.g. easy to chew, chopped, ground, and pureed.

Comments: Coupled with the foodType (Meat).

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:texture-code

Mappings: workflow=Request.code; v2=ODS-4; rim=.code

NutritionOrder.oralDiet.texture.type

Food (i.e. solid and/or liquid) types that undergo texture alteration

Definition: The food (i.e. solid and/or liquid) type(s) (e.g. meats, all foods) that the texture modification applies to.

Cardinality: 0..1

Type: CodeableConcept

Binding: preferred:modified-foodtype

Mappings: workflow=Request.code; v2=ODS-4; rim=.participation[typeCode=PRD].role[classCode=MANU], manufacturedFoodKind; .code

NutritionOrder.oralDiet.instruction

Instructions or additional information about the oral diet

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

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

Cardinality: 0..1

Type: string

Summary: true

Mappings: workflow=Request.supportingInfo; v2=ODS-4; rim=.text

NutritionOrder.oralDiet.caloricDensity

Amount of energy per specified volume of oral diet

Definition: The amount of energy (calories or kilojoules) that the oral diet should provide. For example, an infant formula feeding of 30 ounces of 20 kcal/ounce (67 kcal/100 mL) formula per day.

Cardinality: 0..1

Type: Quantity

NutritionOrder.supplement

Supplement components

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

Conditions: nor-1

Cardinality: 0..*

Type: BackboneElement

Mappings: v2=ODS-1 Value = "P"; rim=.outboundRelationship [typeCode =COMP], target [classCode=SPLY, moodCode=RQO, code=SUPPLEMENT]

NutritionOrder.supplement.type

Type of supplement product requested

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

Cardinality: 0..1

Type: CodeableReference

Binding: preferred:supplement-type

Summary: true

Mappings: workflow=Request.product; w5=FiveWs.what[x]; v2=ODS-3; rim=.participation[typeCode=PRD].role[classCode=MANU], manufacturedFoodKind; .code (NutritionalSupplementType)

NutritionOrder.supplement.productName

Product or brand name of the nutritional supplement

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

Cardinality: 0..1

Type: string

Mappings: v2=ODS-3; rim=.id

NutritionOrder.supplement.schedule

Scheduling information for supplements

Definition: Schedule information for a supplement.

Cardinality: 0..1

Type: BackboneElement

NutritionOrder.supplement.schedule.timing

Scheduled frequency of supplement

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.

Aliases: Frequency

Cardinality: 0..*

Type: Timing

Mappings: workflow=Request.occurrence[x]; v2=ODS-2, TQ1-7/8; rim=.expectedUseTime

NutritionOrder.supplement.schedule.asNeeded

Take 'as needed'

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

Cardinality: 0..1

Type: boolean

NutritionOrder.supplement.schedule.asNeededFor

Take 'as needed' for x

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

Cardinality: 0..1

Type: CodeableConcept

Binding: example:medication-as-needed-reason

NutritionOrder.supplement.quantity

Amount of the nutritional supplement

Definition: The amount of the nutritional supplement to be given.

Cardinality: 0..1

Type: Quantity

Mappings: v2=TQ1-2; rim=.quantity

NutritionOrder.supplement.instruction

Instructions or additional information about the oral supplement

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

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

Cardinality: 0..1

Type: string

Summary: true

Mappings: workflow=Request.supportingInfo; v2=ODS-4; rim=.text

NutritionOrder.supplement.caloricDensity

Amount of energy per specified volume of supplement that is required

Definition: The amount of energy (calories or kilojoules) that the supplement should provide per specified volume, typically per ml or fluid oz. For example, a patient may required a supplement that provides 24 calories per fluid ounce.

Cardinality: 0..1

Type: Quantity

NutritionOrder.enteralFormula

Enteral formula product

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

Conditions: nor-1

Cardinality: 0..1

Type: BackboneElement

Mappings: v2=ODS-1 Value coded for enteral; rim=.outboundRelationship [typeCode =COMP], target [classCode=SPLY, moodCode=RQO, code=FORMULA]

NutritionOrder.enteralFormula.type

Type of patient enteral feeding

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

Cardinality: 0..1

Type: CodeableReference

Binding: preferred:entformula-type

Summary: true

Mappings: workflow=Request.product; w5=FiveWs.what[x]; v2=ODS-3; rim=.participation[typeCode=PRD].role[classCode=MANU], manufacturedFoodKind; .code (NutritionalFormulaType)

NutritionOrder.enteralFormula.productName

Product or brand name of the enteral feeding

Definition: The product or brand name of the enteral feeding product such as "ACME Adult Standard Formula".

Cardinality: 0..1

Type: string

Mappings: v2=ODS-4; rim=.id

NutritionOrder.enteralFormula.deliveryDevice[x]

Intended type of device for the enteral feeding administration

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

Cardinality: 0..1

Type: CodeableConcept, canonical

Binding: example:deliverydevice-code

NutritionOrder.enteralFormula.caloricDensity

Amount of energy per specified volume of feeding that is required

Definition: The amount of energy (calories or kilojoules) that the feeding 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.

Cardinality: 0..1

Type: Quantity

Mappings: v2=TQ1-2; rim=.quantity (caloricDensity)

NutritionOrder.enteralFormula.routeOfAdministration

How the enteral feeding should enter the patient's gastrointestinal tract

Definition: The administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tube, oral.

Cardinality: 0..*

Type: CodeableConcept

Binding: extensible:enteral-route

Mappings: v2=ODS-4; rim=.routeCode

NutritionOrder.enteralFormula.administration

Formula feeding instruction as structured data

Definition: Formula feeding 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.

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

Cardinality: 0..*

Type: BackboneElement

Mappings: v2=ODS-4; rim=.outboundRelationship [typeCode =COMP], target [classCode=SBADM, moodCode=RQO]

NutritionOrder.enteralFormula.administration.schedule

Scheduling information for enteral feeding products

Definition: Schedule information for an enteral feeding.

Cardinality: 0..1

Type: BackboneElement

NutritionOrder.enteralFormula.administration.schedule.timing

Scheduled frequency of enteral feeding

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

Aliases: Frequency

Cardinality: 0..*

Type: Timing

Mappings: workflow=Request.occurrence[x]; v2=ODS-2, TQ1-7/8; rim=.expectedUseTime

NutritionOrder.enteralFormula.administration.schedule.asNeeded

Take 'as needed'

Definition: Indicates whether the enteral feeding is only taken when needed within a specific dosing schedule.

Cardinality: 0..1

Type: boolean

NutritionOrder.enteralFormula.administration.schedule.asNeededFor

Take 'as needed' for x

Definition: Indicates whether the enteral feeding is only taken based on a precondition for taking the enteral feeding.

Cardinality: 0..1

Type: CodeableConcept

Binding: example:medication-as-needed-reason

NutritionOrder.enteralFormula.administration.quantity

The volume of formula feeding to provide

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

Cardinality: 0..1

Type: Quantity

Mappings: v2=TQ1-2; rim=.doseQuantity

NutritionOrder.enteralFormula.administration.rate[x]

Speed with which the formula feeding is provided per period of time

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

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".

Cardinality: 0..1

Type: Quantity, Ratio

Mappings: v2=ODS-4; rim=.rateQuantity

NutritionOrder.enteralFormula.maxVolumeToAdminister

Upper limit on formula feeding volume per unit of time

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

Cardinality: 0..1

Type: Quantity

Mappings: v2=ODS-4; rim=.maxDoseQuantity

NutritionOrder.enteralFormula.administrationInstruction

Formula feeding instructions expressed as text

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

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

Cardinality: 0..1

Type: markdown

Summary: true

Mappings: workflow=Request.supportingInfo; v2=ODS-4; rim=N/A

NutritionOrder.additive

Modular additive to add to the oral diet, supplement, and/or enteral feeding

Definition: Indicates modular components to be provided in addition or mixed with the oral diet, supplement, and/or enteral feeding.

Cardinality: 0..*

Type: BackboneElement

NutritionOrder.additive.modularType

Type of modular component to add to the oral diet, supplement, and/or enteral feeding

Definition: Indicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the oral diet, supplement, and/or enteral feeding.

Cardinality: 0..1

Type: CodeableReference

Binding: preferred:entformula-additive

Mappings: workflow=Request.product; w5=FiveWs.what[x]; v2=ODS-3; rim=N/A (not differentiated from NutritionalFormulaType in HL7 v3)

NutritionOrder.additive.productName

Product or brand name of the modular additive

Definition: The product or brand name of the type of modular additive to be added to the oral diet, supplement, and/or enteral feeding.

Cardinality: 0..1

Type: string

Mappings: v2=ODS-4; rim=N/A

NutritionOrder.additive.quantity

Amount of additive to be given or mixed in with the oral diet, supplement, and/or enteral feeding

Definition: The amount of additive to be given in addition or to be mixed in with the oral diet, supplement, and/or enteral feeding.

Cardinality: 0..1

Type: Quantity

NutritionOrder.additive.routeOfAdministration

How the additive should enter the patient's gastrointestinal tract

Definition: The administration into the patient's gastrointestinal tract for purposes of providing the additive, e.g. nasogastric tube, oral.

Cardinality: 0..*

Type: CodeableConcept

Binding: extensible:enteral-route

Mappings: v2=ODS-4; rim=.routeCode

NutritionOrder.note

Comments

Definition: Comments made about the nutrition order by the requester, performer, subject or other participants.

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.

Cardinality: 0..*

Type: Annotation

Mappings: workflow=Request.note