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HdBe-AllergieIntolerantie

CBB	Concept	Status
HdBe-AllergyIntolerance	Een allergie of intolerantie beschrijft de geneigdheid tot overgevoeligheid van een patiënt voor een stof, zodat na blootstelling een ongewenste fysiologische reactie verwacht wordt, terwijl bij de meeste mensen bij die hoeveelheid geen reactie zou optreden. De waargenomen fysiologische veranderingen zijn meestal het resultaat van een immunologische reactie. De stoffen kunnen als volgt worden ingedeeld: Geneesmiddel Geneesmiddelgroep Ingrediënt/toevoeging Voeding Omgevingsfactor Dier Planten Chemicaliën Inhalatieallergenen Purpose Het vastleggen en doorgeven van allergieën en intoleranties, is een belangrijk onderdeel van de medische registratie. Het raakt de kern van patiëntveiligheid in het algemeen en medicatieveiligheid in het bijzonder. In de uitvoering van onderzoek, behandeling en verzorging moet veelal continu rekening worden gehouden met deze patiëntkenmerken. Allergieën en intoleranties zijn in principe ook aandoeningen en zouden ook als probleem vastegelegd kunnen worden. Het is niettemin gebruikelijk deze separaat vast te leggen. Allergieën/Intoleraties hebben veel gemeen met waarschuwingen (Alert). Belangrijk verschil is dat bij allergieën en intoleranties veel getailleerdere informatie wordt vast gelegd o.a over de reacties op de veroorzakende stof. Daarnaast is niet iedere waarschuwing een probleem of medische conditie. Bij allergie/intolerantie is dit wel het geval, terwijl niet iedere allergie of intolerentie een waarschuwing inhoudt. Evidence Base Om geneesmiddelallergieën in het werkproces van voorschrijvers en apothekers te kunnen registreren en afhandelen (in de medicatiebewaking) wordt in Nederland voor allergieën gebruik gemaakt van de beschikbare coderingen in de G-standaard. Dit is beschreven in het document “Allergieën en ongewenste middelen IR V-2-3-1”. Deze codering is niet toereikend waar het gaat om reacties bij blootstelling aan voedingsmiddelen, artikelen (zoals verbandmiddelen en pleisters), planten en dieren. Voor deze items staat de standaard het gebruik van vrije tekst toe of van SNOMED CT codering. Voor SNOMED CT is echter voor dit doel op dit moment geen gevalideerde valueset beschikbaar. Issues Geen bekende allergieën De vraag is of we in deze bouwsteen een code voor "No known allergies (SNOMED CT 160244002)" en kinderen hiervan aanbieden of dat we stellen dat, waar van toepassing, dat geregeld moet worden in het document waar de bouwsteen wordt toegepast . Valueset voor het concept 'Veroorzakende Stof' Er is momenteel nog geen afgebakende codelijst beschikbaar voor allergene stoffen anders dan medicatie. Daarom is volstaan met het noemen van SNOMED CT voor de codering van allergene stoffen. Voor de codering van medicatieproducten wordt de G-standaard gebruikt. References Z-INDEX. (2011) Allergieën en ongewenste middelen [Online] v. R V-2-3-1 Beschikbaar op: http://www.z-index.nl/g-standaard/beschrijvingen/functioneel/wijzigingen/mb/bewaking-op-allergie/IR%20Allergieen%20V%202-1-1.pdf [Geraadpleegd: 15 oktober 2014] HL7 FHIR Resource AllergyIntolerance. [Online] Continuous Build. Beschikbaar op: http://hl7-fhir.github.io/allergyintolerance.html [Geraadpleegd: 12 maart 2014]	active

CBB

Concept

Status

HdBe-AllergyIntolerance

Een allergie of intolerantie beschrijft de geneigdheid tot overgevoeligheid van een patiënt voor een stof, zodat na blootstelling een ongewenste fysiologische reactie verwacht wordt, terwijl bij de meeste mensen bij die hoeveelheid geen reactie zou optreden. De waargenomen fysiologische veranderingen zijn meestal het resultaat van een immunologische reactie. De stoffen kunnen als volgt worden ingedeeld:

Geneesmiddel
Geneesmiddelgroep
Ingrediënt/toevoeging
Voeding
Omgevingsfactor
Dier
Planten
Chemicaliën
Inhalatieallergenen

Purpose

Het vastleggen en doorgeven van allergieën en intoleranties, is een belangrijk onderdeel van de medische registratie. Het raakt de kern van patiëntveiligheid in het algemeen en medicatieveiligheid in het bijzonder. In de uitvoering van onderzoek, behandeling en verzorging moet veelal continu rekening worden gehouden met deze patiëntkenmerken. Allergieën en intoleranties zijn in principe ook aandoeningen en zouden ook als probleem vastegelegd kunnen worden. Het is niettemin gebruikelijk deze separaat vast te leggen. Allergieën/Intoleraties hebben veel gemeen met waarschuwingen (Alert). Belangrijk verschil is dat bij allergieën en intoleranties veel getailleerdere informatie wordt vast gelegd o.a over de reacties op de veroorzakende stof. Daarnaast is niet iedere waarschuwing een probleem of medische conditie. Bij allergie/intolerantie is dit wel het geval, terwijl niet iedere allergie of intolerentie een waarschuwing inhoudt.

Evidence Base

Om geneesmiddelallergieën in het werkproces van voorschrijvers en apothekers te kunnen registreren en afhandelen (in de medicatiebewaking) wordt in Nederland voor allergieën gebruik gemaakt van de beschikbare coderingen in de G-standaard. Dit is beschreven in het document “Allergieën en ongewenste middelen IR V-2-3-1”.

Deze codering is niet toereikend waar het gaat om reacties bij blootstelling aan voedingsmiddelen, artikelen (zoals verbandmiddelen en pleisters), planten en dieren. Voor deze items staat de standaard het gebruik van vrije tekst toe of van SNOMED CT codering. Voor SNOMED CT is echter voor dit doel op dit moment geen gevalideerde valueset beschikbaar.

Issues Geen bekende allergieën De vraag is of we in deze bouwsteen een code voor "No known allergies (SNOMED CT 160244002)" en kinderen hiervan aanbieden of dat we stellen dat, waar van toepassing, dat geregeld moet worden in het document waar de bouwsteen wordt toegepast . Valueset voor het concept 'Veroorzakende Stof' Er is momenteel nog geen afgebakende codelijst beschikbaar voor allergene stoffen anders dan medicatie. Daarom is volstaan met het noemen van SNOMED CT voor de codering van allergene stoffen. Voor de codering van medicatieproducten wordt de G-standaard gebruikt. References

Z-INDEX. (2011) *Allergieën en ongewenste middelen *[Online] v. R V-2-3-1 Beschikbaar op: http://www.z-index.nl/g-standaard/beschrijvingen/functioneel/wijzigingen/mb/bewaking-op-allergie/IR%20Allergieen%20V%202-1-1.pdf [Geraadpleegd: 15 oktober 2014]
HL7 FHIR Resource AllergyIntolerance. [Online] Continuous Build. Beschikbaar op: http://hl7-fhir.github.io/allergyintolerance.html [Geraadpleegd: 12 maart 2014]

active

AllergyIntolerance			AllergyIntolerance	Element id AllergyIntolerance Short description AllergieIntolerantie Definition Rootconcept van de bouwsteen AllergieIntolerantie. Dit rootconcept bevat alle gegevenselementen van de bouwsteen AllergieIntolerantie. Data type AllergyIntolerance Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id AllergyIntolerance.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id AllergyIntolerance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
CausativeAgent		1..1	CodeableConceptBinding	Element id AllergyIntolerance.CausativeAgent Short description VeroorzakendeStof Definition Stof, groep stoffen of omgevingsfactor waar de patiënt allergisch of overgevoelig voor is. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Belgian refset for causative agent, no drug CausativeAgent (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyCategory		0..1	CodeableConceptBinding	Element id AllergyIntolerance.AllergyCategory Short description AllergieCategorie Definition Identificeert de categorie van de overgevoeligheid aan zoals medicatie, voedsel of omgeving. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding AllergyCategory codes AllergyCategory (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyStatus		0..1	CodeableConceptBinding	Element id AllergyIntolerance.AllergyStatus Short description AllergieStatus Definition Bewering over de status van de overgevoeligheid. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding AllergyStatus codes AllergyStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
StartDateTime		0..1	dateTime	Element id AllergyIntolerance.StartDateTime Short description BeginDatumTijd Definition De datum en tijd dat de allergie of de ongewenste reactie is vastgesteld. Dit kan een exacte datum en tijd zijn maar ook een globale aanduiding van de datum (bijvoorbeeld alleen jaar of jaar en maand). Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Criticality		0..1	CodeableConceptBinding	Element id AllergyIntolerance.Criticality Short description MateVanKritiekZijn Definition Mate van kritiek zijn wordt gedefinieerd als "de potentiële ernst van toekomstige reacties." Dit vertegenwoordigt een klinisch oordeel over het worst case scenario voor een toekomstige reactie. Het kan worden gebaseerd op de ernst van de reacties in het verleden, de dosis en de wijze van blootstelling die in het verleden reacties veroorzaakten, en de levensbedreigende potentie van het type reactie. Mate van kritiek zijn is een kenmerk van de allergische aandoening, niet van de reactie. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Criticality codes CriticalExtent (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
LastReactionDateTime		0..1	dateTime	Element id AllergyIntolerance.LastReactionDateTime Short description LaatsteReactieDatumTijd Definition Opgave van de laatste maal dat een reactie in het licht van de overgevoeligheid is opgetreden. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Comment		0..1	string	Element id AllergyIntolerance.Comment Short description Toelichting Definition Tekstuele toelichting op de overgevoeligheid die niet in één van de andere velden kan worden weergegeven. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Reaction		0..*	BackboneElement	Element id AllergyIntolerance.Reaction Short description Reactie Definition Container van het concept Reactie. Deze container bevat alle gegevenselementen van het concept Reactie. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id AllergyIntolerance.Reaction.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id AllergyIntolerance.Reaction.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id AllergyIntolerance.Reaction.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition 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). Requirements 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. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
Symptom		1..*	CodeableConceptBinding	Element id AllergyIntolerance.Reaction.Symptom Short description Symptoom Definition De inhoudelijke specificatie van de reactie die optreedt indien de patiënt wordt blootgesteld aan de veroorzakende stof. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Symptom codes Symptom (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
SpecificSubstance		0..1	CodeableConceptBinding	Element id AllergyIntolerance.Reaction.SpecificSubstance Short description SpecifiekeStof Definition Meer specifieke aanduiding van de stof die de reactie opriep. Dit kan een specifieke stof uit een groep stoffen zijn waarvoor de patiënt allergisch of overgevoelig is. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Belgian refset for causative agent, no drug CausativeAgent (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
ReactionDescription		0..1	string	Element id AllergyIntolerance.Reaction.ReactionDescription Short description ReactieBeschrijving Definition Tekstuele beschrijving van de reactie als geheel. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Severity		0..1	CodeableConceptBinding	Element id AllergyIntolerance.Reaction.Severity Short description Ernst Definition De ernst van de reactie ten gevolge van de blootgestelling aan de veroorzakende stof. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Severity codes CriticalExtent (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
RouteOfExposure		0..1	CodeableConceptBinding	Element id AllergyIntolerance.Reaction.RouteOfExposure Short description WijzeVanBlootstelling Definition Wijze waarop de patiënt in aanraking is gekomen met de veroorzakende stof of de wijze waarop de stof toegediend is. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding RouteOfExposure codes RouteOfExposure (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
ReactionTime		0..1	dateTime	Element id AllergyIntolerance.Reaction.ReactionTime Short description ReactieTijdstip Definition Datum en tijd waarop de reactie plaats gevonden heeft. Dit mag ook alleen een datum of een gedeeltelijke datum zijn, indien dit niet nauwkeuriger bekend is. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a

AllergyIntolerance		0..*
AllergyIntolerance.CausativeAgent	CodeableConcept	1..1
AllergyIntolerance.AllergyCategory	CodeableConcept	0..1
AllergyIntolerance.AllergyStatus	CodeableConcept	0..1
AllergyIntolerance.StartDateTime	dateTime	0..1
AllergyIntolerance.Criticality	CodeableConcept	0..1
AllergyIntolerance.LastReactionDateTime	dateTime	0..1
AllergyIntolerance.Comment	string	0..1
AllergyIntolerance.Reaction	BackboneElement	0..*
AllergyIntolerance.Reaction.Symptom	CodeableConcept	1..*
AllergyIntolerance.Reaction.SpecificSubstance	CodeableConcept	0..1
AllergyIntolerance.Reaction.ReactionDescription	string	0..1
AllergyIntolerance.Reaction.Severity	CodeableConcept	0..1
AllergyIntolerance.Reaction.RouteOfExposure	CodeableConcept	0..1
AllergyIntolerance.Reaction.ReactionTime	dateTime	0..1

AllergyIntolerance
Definition	Root concept of the AllergyIntolerance information model. This root concept contains all data elements of the AllergyIntolerance information model.
Cardinality	0...*
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
AllergyIntolerance.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
AllergyIntolerance.extension
Definition	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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
AllergyIntolerance.CausativeAgent
Definition	Substance, group of substances or environmental factor to which the patient is allergic or hypersensitive.
Cardinality	1...1
Type	CodeableConcept
Binding	Belgian refset for causative agent, no drug CausativeAgent (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyIntolerance.AllergyCategory
Definition	Identifies the allergy category such as medication, food or environment.
Cardinality	0...1
Type	CodeableConcept
Binding	AllergyCategory codes AllergyCategory (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyIntolerance.AllergyStatus
Definition	Statement on the status of the patient’s hypersensitivity.
Cardinality	0...1
Type	CodeableConcept
Binding	AllergyStatus codes AllergyStatus (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyIntolerance.StartDateTime
Definition	The date and time at which the allergy or undesired reaction was determined. This can be an exact date and time, or a rough indication of the date (such as only the year, or the month and the year).
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
AllergyIntolerance.Criticality
Definition	Critical extent is defined as “the potential severity of future reactions.” This represents a clinical evaluation of the worst case scenario for a future reaction. It can be based on the severity of past reactions, the dose and manner of exposure which caused reactions in the past, and the life-threatening potential of the type of reaction. Critical extent is a property of the allergy, and not of the reaction itself.
Cardinality	0...1
Type	CodeableConcept
Binding	Criticality codes CriticalExtent (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyIntolerance.LastReactionDateTime
Definition	Entry of the last time a hypersensitive reaction took place.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
AllergyIntolerance.Comment
Definition	Textual explanation of the hypersensitivity which cannot be entered in any of the other fields.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
AllergyIntolerance.Reaction
Definition	Container of the Reaction concept. This container contains all data elements of the Reaction concept.
Cardinality	0...*
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
AllergyIntolerance.Reaction.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
AllergyIntolerance.Reaction.extension
Definition	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.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
AllergyIntolerance.Reaction.modifierExtension
Definition	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).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	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.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
AllergyIntolerance.Reaction.Symptom
Definition	The content specifications of the reaction that takes place when the patient is exposed to the causative substance.
Cardinality	1...*
Type	CodeableConcept
Binding	Symptom codes Symptom (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyIntolerance.Reaction.SpecificSubstance
Definition	More specific indication of the substance that caused the reaction. This can be a specific substance from a group of substances to which the patient is allergic or hypersensitive.
Cardinality	0...1
Type	CodeableConcept
Binding	Belgian refset for causative agent, no drug CausativeAgent (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyIntolerance.Reaction.ReactionDescription
Definition	Textual description of the reaction as a whole.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
AllergyIntolerance.Reaction.Severity
Definition	The severity of the reaction as a result of exposure to the causative substance.
Cardinality	0...1
Type	CodeableConcept
Binding	Severity codes CriticalExtent (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyIntolerance.Reaction.RouteOfExposure
Definition	Way in which the patient came into contact with the causative agent or the way in which the agent was administered.
Cardinality	0...1
Type	CodeableConcept
Binding	RouteOfExposure codes RouteOfExposure (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AllergyIntolerance.Reaction.ReactionTime
Definition	Date and time at which the reaction took place. This may also be just the date or a partial date, in the event that the exact date is unknown.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a

Example instances

AllergyIntolerance
CausativeAgent	419442005 - Ethanol (code by SNOMED CT)
AllergyCategory	418471000 - Propensity to adverse reactions to food (code by SNOMED CT)
AllergyStatus	55561003 - Active (code by SNOMED CT)
StartDateTime	2010
criticality	24484000 - Severe (code by SNOMED CT)
LastReactionDateTime	2019-04-21
Comment	Allergic reactions seems to get more severe over time.
reaction	---
reaction.Symptom	126485001 - Urticaria (code by SNOMED CT)
Reaction.SpecificSubstance
Reaction.ReactionDescription
reaction.Severity	24484000 - Severe (code by SNOMED CT)
Reaction.RouteOfExposure	26643006 - Oral route (code by SNOMED CT)
Reaction.ReactionTime	2019-04-21

zib AllergyIntolerance-v3.3 difference

Concept	Category	Description
Description	textual	Removed known issues as they contain Dutch context (G-standard).
`CausativeAgent`	terminology	Replaced existing Codelists with valueSet CausativeAgent which contains Belgian SNOMED refset with code: 751000172100.
`AllergyCategory`	terminology	Added SNOMED CT code for unknown to AllergyCategory valueSet and replaced Other value with SNOMED CT code.
`AllergyStatus`	terminology	Replaced AllergyStatus valueSet values with SNOMED CT codes of active and inactive, which are equal to the values in the AllergyIntolerance-v4.0 2021 pre-adopt version.
`Reaction.Symptom`	terminology	Added SNOMED CT code for unknown to Symptom valueSet and replaced Other value with SNOMED CT code.
`Reaction.Severity`	terminology	Replaced valueSet with CriticalExtent valueSet, which is also used at the `criticality` element, because the codes in the valueset overlap. Morerover, the reaction can not be registered as a fatal reaction too.
`Reaction.SpecificSubstance`	terminology	Replaced existing Codelists with valueSet CausativeAgent which contains Belgian SNOMED refset with code: 751000172100.

Terminology Bindings

Path	Name	Strength	URL
CausativeAgent	CausativeAgent	required	https://fhir.healthdata.be/ValueSet/CausativeAgent
AllergyCategory	AllergyCategory	required	https://fhir.healthdata.be/ValueSet/AllergyCategory
AllergyStatus	AllergyStatus	required	https://fhir.healthdata.be/ValueSet/AllergyStatus
Criticality	CriticalExtent	required	https://fhir.healthdata.be/ValueSet/CriticalExtent
Reaction.Symptom	Symptom	extensible	https://fhir.healthdata.be/ValueSet/Symptom
Reaction.SpecificSubstance	CausativeAgent	required	https://fhir.healthdata.be/ValueSet/CausativeAgent
Reaction.Severity	CriticalExtent	required	https://fhir.healthdata.be/ValueSet/CriticalExtent
Reaction.RouteOfExposure	RouteOfExposure	required	https://fhir.healthdata.be/ValueSet/RouteOfExposure