| AllergyIntolerance | I | | AllergyIntolerance | There are no (further) constraints on this element Element idShort description Allergy or Intolerance (generally: Risk of adverse reaction to a substance) Alternate names Allergy, Intolerance, Adverse Reaction Definition Risk 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.
AllergyIntolerance Constraints- dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
contained.contained.empty() - dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative
contained.text.empty() - dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() - dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
contained.where(('#'+id in %resource.descendants().reference).not()).empty() - ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error.
verificationStatus='entered-in-error' or clinicalStatus.exists() - ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
verificationStatus!='entered-in-error' or clinicalStatus.empty()
- rim: Entity. Role, or Act
- rim: Observation[classCode=OBS, moodCode=EVN]
- w5: clinical.general
|
| id | Σ | 0..1 | id | There are no (further) constraints on this element Element idShort description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
id Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idShort description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Meta Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| 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 Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.
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.
This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| language | | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.language Language of the resource content Definition The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
code Binding A human language. ?? (extensible)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idShort description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource, and may 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 in formation is added later.
Narrative Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- rim: N/A
- rim: Act.text?
|
| contained | | 0..* | Resource | There are no (further) constraints on this element Element idAllergyIntolerance.contained Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
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.
Resource Mappings- rim: Entity. Role, or Act
- rim: N/A
|
| extension | I | 0..* | Extension | Element idAllergyIntolerance.extension 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 resource. In order 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.
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.
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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
|
| Mecanismo | I | 0..* | Extension | Element idAllergyIntolerance.extension:Mecanismo 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 resource. In order 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.
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.
Extension Extension URL http://example.org/fhir/StructureDefinition/Mecanismo Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
|
| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.modifierExtension Extensions that cannot be ignored Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order 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.
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.
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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
|
| identifier | Σ | 0..* | Identifier | There are no (further) constraints on this element Element idAllergyIntolerance.identifier External ids for this item Definition This records identifiers associated with this allergy/intolerance concern that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation).
Identifier Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
- rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
- servd: Identifier
- v2: IAM-7
- rim: id
- w5: id
|
| clinicalStatus | Σ ?! I | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.clinicalStatus active | inactive | resolved Definition The clinical status of the allergy or intolerance.
This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as not currently valid.
code Binding The clinical status of the allergy or intolerance. ?? (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- rim: Observation ACT
.inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
- w5: status
|
| verificationStatus | Σ ?! I | 1..1 | codeBinding | Element idAllergyIntolerance.verificationStatus Sospechada | Probable | Confirmada | Resuelta | Descartada Definition Afirmación sobre la certeza del posible riesgo futuro de desarrollo de efecto adverso por exposición a la 'Sustancia' identificada.
Los SSII pueden optar por no mostrar las entradas de reacciones adversas con valor de estado "Refutado" en la Lista de reacciones adversas. Sin embargo, 'Refutado' puede ser útil para la reconciliación de la lista de reacciones adversas o cuando se comunica entre sistemas.
This element is labeled as a modifier because the status contains the codes refuted and entered-in-error that mark the AllergyIntolerance as not currently valid.
code Binding Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance. ?? (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- rim: Observation ACT
.inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
- w5: status
|
| type | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idShort description allergy | intolerance - Underlying mechanism (if known) Alternate names Category, Class Definition Identification 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 may 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 may 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.
code Binding Identification of the underlying physiological mechanism for a Reaction Risk. ?? (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: IAM-9
- rim: code
- w5: class
|
| category | Σ | 0..* | codeBinding | Element idAllergyIntolerance.category Medicamento | Alimento | Otros Alternate names Category, Type, Reaction Type, Class Definition Cada una de las sustancias del listado pertenecerá a una de las tres opciones. Se calculará a partir del campo sustancia.
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.
code Binding Category of an identified substance. ?? (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: AL1-2
- rim: value < IntoleranceValue (Agent)
- w5: class
|
| criticality | Σ | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.criticality low | high | unable-to-assess Alternate names Severity, Seriousness, Contra-indication, Risk Definition Estimate 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.
code Binding Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance. ?? (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: AL1-4
- rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]
- w5: grade
|
| code | Σ | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idShort description Code that identifies the allergy or intolerance Alternate names Code Definition Code for an allergy or intolerance statement (either a positive or a negated/excluded statement). This may be a code for a substance or pharmaceutical product that is considered to be responsible for the adverse reaction risk (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a negated/excluded code for a specific substance or class (e.g., "No latex allergy") or a general or categorical negated statement (e.g., "No known allergy", "No known drug allergies").
It is strongly recommended that this element be populated using a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNI, ATC and CPT. Plain text should only be used if there is no appropriate terminology available. Additional details can be specified in the text.
When a substance or product code is specified for the 'code' element, the "default" semantic context is that this is a positive statement of an allergy or intolerance (depending on the value of the 'type' element, if present) condition to the specified substance/product. In the corresponding SNOMED CT allergy model, the specified substance/product is the target (destination) of the "Causative agent" relationship.
The 'substanceExposureRisk' extension is available as a structured and more flexible alternative to the 'code' element for making positive or negative allergy or intolerance statements. This extension provides the capability to make "no known allergy" (or "no risk of adverse reaction") statements regarding any coded substance/product (including cases when a pre-coordinated "no allergy to x" concept for that substance/product does not exist). If the 'substanceExposureRisk' extension is present, the AllergyIntolerance.code element SHALL be omitted.
CodeableConcept Binding Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies. ?? (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: AL1-3 / IAM-3
- rim: substance/product:
.participation[typeCode=CAGNT].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]
negated/excluded substance/product:
.participation[typeCode=CAGNT, negationInd=true].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]
positive or negated/excluded condition/situation:
Observation.code=ASSERTION; Observation.value
- w5: what
|
| patient | Σ I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient) | There are no (further) constraints on this element Element idAllergyIntolerance.patient Who the sensitivity is for Alternate names Patient Definition The 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.
Reference(http://hl7.org/fhir/StructureDefinition/Patient) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))
- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2: (PID-3)
- rim: .participation[typeCode=SBJ].role[classCode=PAT]
- w5: who.focus
|
| onset[x] | | 0..1 | | There are no (further) constraints on this element Element idAllergyIntolerance.onset[x] When allergy or intolerance was identified Definition Estimated or actual date, date-time, or age when allergy or intolerance was identified.
- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- rim: effectiveTime.low
- w5: when.init
|
| onsetDateTime | | | dateTime | There are no (further) constraints on this element Data type dateTime |
| onsetAge | | | Age | There are no (further) constraints on this element Data type Age |
| onsetPeriod | | | Period | There are no (further) constraints on this element Data type Period |
| onsetRange | | | Range | There are no (further) constraints on this element Data type Range |
| onsetString | | | string | There are no (further) constraints on this element Data type string |
| assertedDate | | 0..1 | dateTime | Element idAllergyIntolerance.assertedDate Date record was believed accurate Definition Los sistemas informáticos deberían ofertar una edad, unos años trascurridos, un año o una fecha y a partir del valor introducido calcular la fecha. Se almacenará la fecha calculada aunque sea aproximada. Cuando el cálculo de como resultado un año se almacenará 15/06/año
dateTime Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: IAM-20
- rim: .participation[typeCode=AUT].time
- w5: when.recorded
|
| recorder | I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/Patient) | There are no (further) constraints on this element Element idAllergyIntolerance.recorder Who recorded the sensitivity Alternate names Author Definition Individual 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(http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/Patient) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))
- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- rim: .participation[typeCode=AUT].role
- w5: who.author
|
| asserter | Σ I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson | http://hl7.org/fhir/StructureDefinition/Practitioner) | There are no (further) constraints on this element Element idAllergyIntolerance.asserter Source of the information about the allergy Alternate names Source, Informant Definition The source of the information about the allergy that is recorded.
The recorder takes repsonsibility for the content, but can reference the source from where they got it.
Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson | http://hl7.org/fhir/StructureDefinition/Practitioner) Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count()) - ref-1: SHALL have a contained resource if a local reference is provided
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))
- rim: n/a
- rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
- v2: IAM-14 (if patient) / IAM-18 (if practitioner)
- rim: .participation[typeCode=INF].role
- w5: who.source
|
| lastOccurrence | | 0..1 | dateTime | Element idAllergyIntolerance.lastOccurrence Date(/time) of last known occurrence of a reaction Definition Los sistemas informáticos debería ofertar una edad, unos años trascurridos, un año o una fecha y a partir del valor introducido calcular la fecha
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.
dateTime Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- rim: outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)].effectiveTime
|
| note | | 0..1 | Annotation | Element idShort description Additional text not captured in other fields Definition Texto breve limitado a 255 caracteres
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.
Annotation Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: N/A
- rim: Act
- rim: subjectOf.observationEvent[code="annotation"].value
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.note.id xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.note.extension 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. In order 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.
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.
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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
|
| author[x] | Σ | 0..1 | | There are no (further) constraints on this element Element idAllergyIntolerance.note.author[x] Individual responsible for the annotation Definition The individual responsible for making the annotation.
- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: N/A
- rim: Act.participant[typeCode=AUT].role
|
| authorString | | | string | There are no (further) constraints on this element Data type string |
| authorReference | | | Reference(http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson) | There are no (further) constraints on this element Data type Reference(http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/RelatedPerson) |
| time | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idAllergyIntolerance.note.time When the annotation was made Definition Indicates when this particular annotation was made.
dateTime Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: N/A
- rim: Act.effectiveTime
|
| text | | 1..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.note.text The annotation - text content Definition The text of the annotation.
Note that FHIR strings may not exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: N/A
- rim: Act.text
|
| reaction | | 0..* | BackboneElement | There are no (further) constraints on this element Element idAllergyIntolerance.reaction Adverse Reaction Events linked to exposure to substance Definition Details about each adverse reaction event linked to exposure to the identified substance.
BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- rim: outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)]
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.id xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.extension 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. In order 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.
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.
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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
|
| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.modifierExtension Extensions that cannot be ignored 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 that contains it. Usually modifier elements provide negation or qualification. In order 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.
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.
Extension Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
|
| substance | | 1..1 | CodeableConcept | Element idAllergyIntolerance.reaction.substance Specific substance or pharmaceutical product considered to be responsible for event Definition Sustancia, o clase de sustancia, que se considera que pone al individuo en riesgo de un evento adverso.
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 identifed 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'.
CodeableConcept Binding Codes defining the type of the substance (including pharmaceutical products). ?? (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- rim: outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].participation[typeCode=CSM].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]
|
| manifestation | | 1..* | CodeableConcept | Element idAllergyIntolerance.reaction.manifestation Clinical symptoms/signs associated with the Event Alternate names Symptoms, Signs Definition Puede tener múltiples valores. En OpenEHR y HL7 este campo pertenece a los registros de eventos adversos asociados
Manifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.
CodeableConcept Binding Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event. ?? (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- v2: AL1-5
- rim: code
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.id xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.extension 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. In order 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.
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.
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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
|
| coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.coding Code defined by a terminology system Definition A reference to a code defined by a terminology system.
Allows for translations and alternate encodings within a code system. Also supports communication of the same instance to systems requiring different encodings.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Coding Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
- rim: CV
- orim: fhir:Coding rdfs:subClassOf dt:CDCoding
- v2: C*E.1-8, C*E.10-22
- rim: union(., ./translation)
- orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
|
| id | | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.coding.id xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.coding.extension 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. In order 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.
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.
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() | (children().count() > id.count()) - ext-1: Must have either extensions or value[x], not both
extension.exists() != value.exists()
|
| system | Σ | 0..1 | uriFixed Value | Element idAllergyIntolerance.reaction.manifestation.coding.system Identity of the terminology system Definition The identification of the code system that defines the meaning of the symbol in the code.
Need to be unambiguous about the source of the definition of the symbol.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: C*E.3
- rim: ./codeSystem
- orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
|
| version | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.coding.version Version of the system - if relevant Definition The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: C*E.7
- rim: ./codeSystemVersion
- orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
|
| code | Σ | 0..1 | code | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.coding.code Symbol in syntax defined by the system Definition A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Need to refer to a particular code in the system.
Note that FHIR strings may not exceed 1MB in size
code Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: C*E.1
- rim: ./code
- orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
|
| display | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.coding.display Representation defined by the system Definition A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
Note that FHIR strings may not exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: C*E.2 - but note this is not well followed
- rim: CV.displayName
- orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
|
| userSelected | Σ | 0..1 | boolean | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.coding.userSelected If this coding was chosen directly by the user Definition Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
boolean Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: Sometimes implied by being first
- rim: CD.codingRationale
- orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
|
| text | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation.text Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
Very often the text is the same as a displayName of one of the codings.
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: C*E.9. But note many systems use C*E.2 for this
- rim: ./originalText[mediaType/code="text/plain"]/data
- orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
|
| description | | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.description Description of the event as a whole Alternate names Narrative, Text Definition Text 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.
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
|
| onset | | 0..1 | dateTime | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.onset Date(/time) when manifestations showed Definition Record of the date and/or time of the onset of the Reaction.
dateTime Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: AL1-6
- rim: effectiveTime.low
|
| severity | | 0..1 | codeBinding | Element idAllergyIntolerance.reaction.severity Baja | Alta | Indeterminada Definition
- Baja: La exposición a la sustancia es poco probable que dé como resultado un daño crítico que ponga en peligro la vida. La exposición futura a la 'Sustancia' identificada debe considerarse una contraindicación relativa en circunstancias clínicas normales.
- Alta: La exposición a la sustancia puede provocar un daño grave y ser potencialmente mortal. La exposición futura a la 'Sustancia' identificada debe considerarse una contraindicación absoluta en circunstancias clínicas normales.
- Indeterminado: No se puede evaluar con información disponible.
It is acknowledged that this assessment is very subjective. There may be some some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions.
code Binding Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations. ?? (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]
|
| exposureRoute | | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.exposureRoute How the subject was exposed to the substance Definition Identification 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.
CodeableConcept Binding A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. ?? (example)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: CE/CNE/CWE
- rim: CD
- orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
- rim: outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].routeCode
|
| note | | 0..* | Annotation | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.note Text about event not captured in other fields Definition Additional 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.
Annotation Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: N/A
- rim: Act
- rim: subjectOf.observationEvent[code="annotation"].value
|
