AllergyIntolerance
- Profile status:
Draft
- Canonical URL:
http://fhir.smart4health.eu/StructureDefinition/s4h-allergyintolerance
The Smart4Health AllergyIntolerance profile is very close to the IPS AllergyIntolerance profile, but diverges by not requiring a literal reference (subject.reference
) to a Patient resource.
Mandatory and must-support data elements
A valid instance according to this profile must satisfy the following constraints:
- have a code describing the allergy or intolerance (element:
code
) - Smart4Health constraint, in line with the AllergyIntolerance profile from the IPS IG - point to the patient that is the subject of the statement (element:
subject
) - base constraint
In addition, nine top-level elements and one top-level extension (taken over from IPS) are marked as must-support.
Guidance on filling AllergyIntolerance instances
We follow IPS in recommending that the absence of an allergy (or the absence of information about allergies) be indicated in the code
element using the special codes defined by IPS for this purpose. See the corresponding slice on the code
element in the profile below for details.
For medication allergies, please follow the guidelines for the use of medication codes given in the documentation of the use of the Medication resource in this IG.
Examples
- Minimal example: AllergyIntolerance - s4h-minimal-allergies-example
- Allergy given as a condition: AllergyIntolerance - s4h-gold-allergy-given-as-disease-example
- Allergy indicated using a substance: AllergyIntolerance - s4h-gold-allergy-given-as-substance-example
- Grass allergy (with only Latin display text): AllergyIntolerance - s4h-difficult-name-grass-allergy-example
- Medication allergy indicated using ATC code: AllergyIntolerance - s4h-medication-allergy-atc-code-example
- Medication allergy indicated using text only: AllergyIntolerance - s4h-medication-allergy-text-only-example
- Allergy with reaction information: AllergyIntolerance - s4h-allergy-with-reaction-example
- An abated allergy (using IPS extension): AllergyIntolerance - s4h-abated-allergy-ips-example
- No known allergies (using IPS code): AllergyIntolerance - s4h-no-known-allergies-ips-example
- No known food allergies (using SNOMED code): AllergyIntolerance - s4h-no-known-food-allergies-snomed-example
- No allergy information (using IPS code): AllergyIntolerance - s4h-no-allergy-information-ips-example
- Allergy resource that was entered in error: AllergyIntolerance - s4h-entered-in-error-example
Formal views of profile content
Differential view
Shows only differences relative to the base resource definition.
S4hAllergyIntolerance (AllergyIntolerance) | S I | AllergyIntolerance | There are no (further) constraints on this element Element idAllergyIntolerance Allergy or Intolerance (generally: Risk of adverse reaction to a substance) Alternate namesAllergy, Intolerance, Adverse Reaction DefinitionRisk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance. Substances include, but are not limited to: a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.id Logical id of this artifact DefinitionThe 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. |
meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idAllergyIntolerance.meta Metadata about the resource DefinitionThe 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.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idAllergyIntolerance.implicitRules A set of rules under which this content was created DefinitionA 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.language Language of the resource content DefinitionThe 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). A human language.
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text | 0..1 | Narrative | There are no (further) constraints on this element Element idAllergyIntolerance.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idAllergyIntolerance.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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extension | I | 0..* | Extension | Element idAllergyIntolerance.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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abatement-datetime | S I | 0..1 | Extension(dateTime) | Element idAllergyIntolerance.extension:abatement-datetime Abatement datetime Alternate namesextensions, user content DefinitionThe date or estimated date that the condition resolved or went into remission. 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. http://hl7.org/fhir/uv/ips/StructureDefinition/abatement-dateTime-uv-ips Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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). 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idAllergyIntolerance.identifier External ids for this item DefinitionBusiness identifiers assigned to this AllergyIntolerance by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers. 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.
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clinicalStatus | S Σ ?! I | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.clinicalStatus Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. The clinical status of the allergy or intolerance.
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verificationStatus | S Σ ?! I | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.verificationStatus Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
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type | S Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.type allergy | intolerance - Underlying mechanism (if known) Alternate namesCategory, Class DefinitionIdentification of the underlying physiological mechanism for the reaction risk. Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians might not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts might not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource. Identification of the underlying physiological mechanism for a Reaction Risk.
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category | Σ | 0..* | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.category food | medication | environment | biologic Alternate namesCategory, Type, Reaction Type, Class DefinitionCategory of the identified substance. This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the substance where coding systems are used, and is effectively redundant in that situation. When searching on category, consider the implications of AllergyIntolerance resources without a category. For example, when searching on category = medication, medication allergies that don't have a category valued will not be returned. Refer to search for more information on how to search category with a :missing modifier to get allergies that don't have a category. Additionally, category should be used with caution because category can be subjective based on the sender. Category of an identified substance associated with allergies or intolerances.
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criticality | S Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.criticality low | high | unable-to-assess Alternate namesSeverity, Seriousness, Contra-indication, Risk DefinitionEstimate of the potential clinical harm, or seriousness, of the reaction to the identified substance. The default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). Systems that capture a severity at the condition level are actually representing the concept of criticality whereas the severity documented at the reaction level is representing the true reaction severity. Existing systems that are capturing both condition criticality and reaction severity may use the term "severity" to represent both. Criticality is the worst it could be in the future (i.e. situation-agnostic) whereas severity is situation-dependent. Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
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code | S Σ | 1..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.code Concept - reference to a terminology or just text Alternate namesCode DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. Unordered, Open, by $this(Pattern) Discriminated by the bound value set Binding Type of the substance/product, allergy or intolerance condition.
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allergyIntoleranceGPSCode | S Σ | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.code:allergyIntoleranceGPSCode Code for allergy or intolerance from the SNOMED CT GPS code set Alternate namesCode DefinitionCode for an allergy or intolerance statement that is selected from the SNOMED CT GPS code set. 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. Codes for allergy or intolerance from the SNOMED CT GPS code set
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absentOrUnknownAllergyIntolerance | S Σ | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.code:absentOrUnknownAllergyIntolerance Code for absent or unknown allergy or intolerance Alternate namesCode DefinitionCode for an allergy or intolerance statement (either a positive or a negated/excluded statement). This describes a categorical negated statement (e.g., "No known allergy"). 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. negation/exclusion codes for reporting no known allergies or not available data.
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patient | S Σ I | 1..1 | Reference(PatientUvIps) | Element idAllergyIntolerance.patient Who the sensitivity is for Alternate namesPatient DefinitionThe patient who has the allergy or intolerance. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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id | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.patient.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.patient.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.patient.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
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type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idAllergyIntolerance.patient.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idAllergyIntolerance.patient.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.patient.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
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encounter | I | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idAllergyIntolerance.encounter Encounter when the allergy or intolerance was asserted DefinitionThe encounter when the allergy or intolerance was asserted. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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onset[x] | 0..1 | Element idAllergyIntolerance.onset[x] When allergy or intolerance was identified DefinitionEstimated or actual date, date-time, or age when allergy or intolerance was identified. Unordered, ??, by $this(Type) Constraints
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(All Slices) | There are no (further) constraints on this element | |||
onsetAge | Age | There are no (further) constraints on this element Data type | ||
onsetPeriod | Period | There are no (further) constraints on this element Data type | ||
onsetRange | Range | There are no (further) constraints on this element Data type | ||
onsetString | string | There are no (further) constraints on this element Data type | ||
onsetDateTime | S | 0..1 | dateTime | Element idAllergyIntolerance.onset[x]:onsetDateTime When allergy or intolerance was identified DefinitionEstimated or actual date, date-time, or age when allergy or intolerance was identified.
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recordedDate | 0..1 | dateTime | There are no (further) constraints on this element Element idAllergyIntolerance.recordedDate Date first version of the resource instance was recorded DefinitionThe recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date.
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recorder | I | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) | There are no (further) constraints on this element Element idAllergyIntolerance.recorder Who recorded the sensitivity Alternate namesAuthor DefinitionIndividual who recorded the record and takes responsibility for its content. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) Constraints
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asserter | S Σ I | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idAllergyIntolerance.asserter Source of the information about the allergy Alternate namesSource, Informant DefinitionThe source of the information about the allergy that is recorded. The recorder takes responsibility for the content, but can reference the source from where they got it. Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) Constraints
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lastOccurrence | 0..1 | dateTime | There are no (further) constraints on this element Element idAllergyIntolerance.lastOccurrence Date(/time) of last known occurrence of a reaction DefinitionRepresents the date and/or time of the last known occurrence of a reaction event. This date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used.
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note | 0..* | Annotation | There are no (further) constraints on this element Element idAllergyIntolerance.note Additional text not captured in other fields DefinitionAdditional narrative about the propensity for the Adverse Reaction, not captured in other fields. For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.
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reaction | S | 0..* | BackboneElement | There are no (further) constraints on this element Element idAllergyIntolerance.reaction Adverse Reaction Events linked to exposure to substance DefinitionDetails about each adverse reaction event linked to exposure to the identified substance.
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id | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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 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. 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.
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substance | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.substance Specific substance or pharmaceutical product considered to be responsible for event DefinitionIdentification of the specific substance (or pharmaceutical product) considered to be responsible for the Adverse Reaction event. Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk, but it must be consistent with it. For instance, it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'. If a receiving system is unable to confirm that AllergyIntolerance.reaction.substance falls within the semantic scope of AllergyIntolerance.code, then the receiving system should ignore AllergyIntolerance.reaction.substance. Coding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, "penicillins"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, "amoxycillin"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'. Codes defining the type of the substance (including pharmaceutical products).
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manifestation | S | 1..* | CodeableConceptIPS | Element idAllergyIntolerance.reaction.manifestation Concept - reference to a terminology or just text Alternate namesSymptoms, Signs DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. Unordered, Open, by $this(Pattern) Discriminated by the bound value set Binding Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
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allergyIntoleranceReactionManifestationGPSCode | S | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.reaction.manifestation:allergyIntoleranceReactionManifestationGPSCode Code for the allergy or intolerance reaction manifestation from the SNOMED CT GPS code set Alternate namesSymptoms, Signs DefinitionCode for an allergy or intolerance reaction manifestation statement that is selected from the SNOMED CT GPS code set. 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. Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
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description | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.description Description of the event as a whole Alternate namesNarrative, Text DefinitionText description about the reaction as a whole, including details of the manifestation if required. Use the description to provide any details of a particular event of the occurred reaction such as circumstances, reaction specifics, what happened before/after. Information, related to the event, but not describing a particular care should be captured in the comment field. For example: at the age of four, the patient was given penicillin for strep throat and subsequently developed severe hives.
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onset | S | 0..1 | dateTime | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.onset Date(/time) when manifestations showed DefinitionRecord of the date and/or time of the onset of the Reaction.
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severity | S | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.severity mild | moderate | severe (of event as a whole) DefinitionClinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations. It is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions. Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
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exposureRoute | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.exposureRoute How the subject was exposed to the substance DefinitionIdentification of the route by which the subject was exposed to the substance. Coding of the route of exposure with a terminology should be used wherever possible. A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
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note | 0..* | Annotation | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.note Text about event not captured in other fields DefinitionAdditional text about the adverse reaction event not captured in other fields. Use this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased.
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Snapshot view
Shows all constraints, including those from underlying profiles and the base resource definition.
S4hAllergyIntolerance (AllergyIntolerance) | S I | AllergyIntolerance | There are no (further) constraints on this element Element idAllergyIntolerance Allergy or Intolerance (generally: Risk of adverse reaction to a substance) Alternate namesAllergy, Intolerance, Adverse Reaction DefinitionRisk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance. Substances include, but are not limited to: a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.id Logical id of this artifact DefinitionThe 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. |
meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idAllergyIntolerance.meta Metadata about the resource DefinitionThe 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.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idAllergyIntolerance.implicitRules A set of rules under which this content was created DefinitionA 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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.language Language of the resource content DefinitionThe 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). A human language.
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text | 0..1 | Narrative | There are no (further) constraints on this element Element idAllergyIntolerance.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA 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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idAllergyIntolerance.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese 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. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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extension | I | 0..* | Extension | Element idAllergyIntolerance.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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abatement-datetime | S I | 0..1 | Extension(dateTime) | Element idAllergyIntolerance.extension:abatement-datetime Abatement datetime Alternate namesextensions, user content DefinitionThe date or estimated date that the condition resolved or went into remission. 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. http://hl7.org/fhir/uv/ips/StructureDefinition/abatement-dateTime-uv-ips Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay 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). 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idAllergyIntolerance.identifier External ids for this item DefinitionBusiness identifiers assigned to this AllergyIntolerance by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers. 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.
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clinicalStatus | S Σ ?! I | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.clinicalStatus Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. The clinical status of the allergy or intolerance.
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verificationStatus | S Σ ?! I | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.verificationStatus Concept - reference to a terminology or just text DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
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type | S Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.type allergy | intolerance - Underlying mechanism (if known) Alternate namesCategory, Class DefinitionIdentification of the underlying physiological mechanism for the reaction risk. Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians might not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts might not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource. Identification of the underlying physiological mechanism for a Reaction Risk.
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category | Σ | 0..* | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.category food | medication | environment | biologic Alternate namesCategory, Type, Reaction Type, Class DefinitionCategory of the identified substance. This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the substance where coding systems are used, and is effectively redundant in that situation. When searching on category, consider the implications of AllergyIntolerance resources without a category. For example, when searching on category = medication, medication allergies that don't have a category valued will not be returned. Refer to search for more information on how to search category with a :missing modifier to get allergies that don't have a category. Additionally, category should be used with caution because category can be subjective based on the sender. Category of an identified substance associated with allergies or intolerances.
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criticality | S Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.criticality low | high | unable-to-assess Alternate namesSeverity, Seriousness, Contra-indication, Risk DefinitionEstimate of the potential clinical harm, or seriousness, of the reaction to the identified substance. The default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). Systems that capture a severity at the condition level are actually representing the concept of criticality whereas the severity documented at the reaction level is representing the true reaction severity. Existing systems that are capturing both condition criticality and reaction severity may use the term "severity" to represent both. Criticality is the worst it could be in the future (i.e. situation-agnostic) whereas severity is situation-dependent. Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
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code | S Σ | 1..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.code Concept - reference to a terminology or just text Alternate namesCode DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. Unordered, Open, by $this(Pattern) Discriminated by the bound value set Binding Type of the substance/product, allergy or intolerance condition.
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allergyIntoleranceGPSCode | S Σ | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.code:allergyIntoleranceGPSCode Code for allergy or intolerance from the SNOMED CT GPS code set Alternate namesCode DefinitionCode for an allergy or intolerance statement that is selected from the SNOMED CT GPS code set. 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. Codes for allergy or intolerance from the SNOMED CT GPS code set
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absentOrUnknownAllergyIntolerance | S Σ | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.code:absentOrUnknownAllergyIntolerance Code for absent or unknown allergy or intolerance Alternate namesCode DefinitionCode for an allergy or intolerance statement (either a positive or a negated/excluded statement). This describes a categorical negated statement (e.g., "No known allergy"). 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. negation/exclusion codes for reporting no known allergies or not available data.
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patient | S Σ I | 1..1 | Reference(PatientUvIps) | Element idAllergyIntolerance.patient Who the sensitivity is for Alternate namesPatient DefinitionThe patient who has the allergy or intolerance. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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id | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.patient.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.patient.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.patient.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
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type | Σ | 0..1 | uriBinding | There are no (further) constraints on this element Element idAllergyIntolerance.patient.type Type the reference refers to (e.g. "Patient") DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Aa resource (or, for logical models, the URI of the logical model).
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identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idAllergyIntolerance.patient.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.patient.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
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encounter | I | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idAllergyIntolerance.encounter Encounter when the allergy or intolerance was asserted DefinitionThe encounter when the allergy or intolerance was asserted. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
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onset[x] | 0..1 | Element idAllergyIntolerance.onset[x] When allergy or intolerance was identified DefinitionEstimated or actual date, date-time, or age when allergy or intolerance was identified. Unordered, ??, by $this(Type) Constraints
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(All Slices) | There are no (further) constraints on this element | |||
onsetAge | Age | There are no (further) constraints on this element Data type | ||
onsetPeriod | Period | There are no (further) constraints on this element Data type | ||
onsetRange | Range | There are no (further) constraints on this element Data type | ||
onsetString | string | There are no (further) constraints on this element Data type | ||
onsetDateTime | S | 0..1 | dateTime | Element idAllergyIntolerance.onset[x]:onsetDateTime When allergy or intolerance was identified DefinitionEstimated or actual date, date-time, or age when allergy or intolerance was identified.
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recordedDate | 0..1 | dateTime | There are no (further) constraints on this element Element idAllergyIntolerance.recordedDate Date first version of the resource instance was recorded DefinitionThe recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date.
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recorder | I | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) | There are no (further) constraints on this element Element idAllergyIntolerance.recorder Who recorded the sensitivity Alternate namesAuthor DefinitionIndividual who recorded the record and takes responsibility for its content. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) Constraints
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asserter | S Σ I | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | There are no (further) constraints on this element Element idAllergyIntolerance.asserter Source of the information about the allergy Alternate namesSource, Informant DefinitionThe source of the information about the allergy that is recorded. The recorder takes responsibility for the content, but can reference the source from where they got it. Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) Constraints
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lastOccurrence | 0..1 | dateTime | There are no (further) constraints on this element Element idAllergyIntolerance.lastOccurrence Date(/time) of last known occurrence of a reaction DefinitionRepresents the date and/or time of the last known occurrence of a reaction event. This date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used.
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note | 0..* | Annotation | There are no (further) constraints on this element Element idAllergyIntolerance.note Additional text not captured in other fields DefinitionAdditional narrative about the propensity for the Adverse Reaction, not captured in other fields. For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.
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reaction | S | 0..* | BackboneElement | There are no (further) constraints on this element Element idAllergyIntolerance.reaction Adverse Reaction Events linked to exposure to substance DefinitionDetails about each adverse reaction event linked to exposure to the identified substance.
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id | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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 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. 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.
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substance | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.substance Specific substance or pharmaceutical product considered to be responsible for event DefinitionIdentification of the specific substance (or pharmaceutical product) considered to be responsible for the Adverse Reaction event. Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk, but it must be consistent with it. For instance, it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'. If a receiving system is unable to confirm that AllergyIntolerance.reaction.substance falls within the semantic scope of AllergyIntolerance.code, then the receiving system should ignore AllergyIntolerance.reaction.substance. Coding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, "penicillins"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, "amoxycillin"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'. Codes defining the type of the substance (including pharmaceutical products).
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manifestation | S | 1..* | CodeableConceptIPS | Element idAllergyIntolerance.reaction.manifestation Concept - reference to a terminology or just text Alternate namesSymptoms, Signs DefinitionA concept that may be defined by a formal reference to a terminology or ontology or may be provided by text. 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. Unordered, Open, by $this(Pattern) Discriminated by the bound value set Binding Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
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allergyIntoleranceReactionManifestationGPSCode | S | 0..1 | CodeableConceptIPSBinding | Element idAllergyIntolerance.reaction.manifestation:allergyIntoleranceReactionManifestationGPSCode Code for the allergy or intolerance reaction manifestation from the SNOMED CT GPS code set Alternate namesSymptoms, Signs DefinitionCode for an allergy or intolerance reaction manifestation statement that is selected from the SNOMED CT GPS code set. 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. Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
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description | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.description Description of the event as a whole Alternate namesNarrative, Text DefinitionText description about the reaction as a whole, including details of the manifestation if required. Use the description to provide any details of a particular event of the occurred reaction such as circumstances, reaction specifics, what happened before/after. Information, related to the event, but not describing a particular care should be captured in the comment field. For example: at the age of four, the patient was given penicillin for strep throat and subsequently developed severe hives.
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onset | S | 0..1 | dateTime | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.onset Date(/time) when manifestations showed DefinitionRecord of the date and/or time of the onset of the Reaction.
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severity | S | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.severity mild | moderate | severe (of event as a whole) DefinitionClinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations. It is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions. Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
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exposureRoute | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.exposureRoute How the subject was exposed to the substance DefinitionIdentification of the route by which the subject was exposed to the substance. Coding of the route of exposure with a terminology should be used wherever possible. A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
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note | 0..* | Annotation | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.note Text about event not captured in other fields DefinitionAdditional text about the adverse reaction event not captured in other fields. Use this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased.
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