AllergyIntollerance
Full Profile Definition: | Profile: Allergy Intolerance |
Resource Content:
Differential
AllergyIntolerance | 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 DefinitionThe US Core Allergies Profile is based upon the core FHIR AllergyIntolerance Resource and created to meet the 2015 Edition Common Clinical Data Set 'Medical allergies' requirements. 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 | 1..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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id | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.meta.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.meta.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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versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idAllergyIntolerance.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
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lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idAllergyIntolerance.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
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meta-source | Σ | 1..1 | uri | Element idAllergyIntolerance.meta.source:meta-source uri of the data source DefinitionTypically the data owner's URL followed by a source/file description mandatory for all resources in bWell's FHIR Server In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
example of meta.source https://www.icanbwell.com/provider-directory Mappings
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profile | Σ | 0..* | canonical(StructureDefinition) | There are no (further) constraints on this element Element idAllergyIntolerance.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. canonical(StructureDefinition) Constraints
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meta-security | Σ | 1..* | CodingBinding | Element idAllergyIntolerance.meta.security:meta-security security tags representing the data's owner, vendor, and accessibility Definitiondata owner: data vendor: data access: /owner & /access are mandatory for all resources in bWell's FHIR Server The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
example of data owner security tag { "system": "https://www.icanbwell.com/owner", "code": "bwell" } example of data access security tag { "system": "https://www.icanbwell.com/access", "code": "bwell" } example of data vendor security tag { "system": "https://www.icanbwell.com/vendor", "code": "bwell" } Mappings
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tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idAllergyIntolerance.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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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 | There are no (further) constraints on this element 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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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 | Element idAllergyIntolerance.identifier a value to identify the resource by 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. Unordered, Open, by slice by types Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | 1..1 | string | Element idAllergyIntolerance.identifier.id set case-by-case 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.identifier.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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use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.use usual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known .
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type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
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system | Σ | 0..1 | uri | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.system The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Identifier.system is always case sensitive.
General http://www.acme.com/identifiers/patient Mappings
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value | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.value The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
General 123456 Mappings
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period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
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assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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clinicalStatus | S Σ ?! I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idAllergyIntolerance.clinicalStatus active | inactive | resolved DefinitionThe clinical status of the allergy or intolerance. Refer to discussion if clincalStatus is missing data. The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity. The clinical status of the allergy or intolerance.
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verificationStatus | S Σ ?! I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idAllergyIntolerance.verificationStatus unconfirmed | confirmed | refuted | entered-in-error DefinitionAssertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product). The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity. Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
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type | 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 | 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 | CodeableConceptBinding | Element idAllergyIntolerance.code The allergen Alternate namesCode DefinitionCode 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"). 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. 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, UNII, and ATC. 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. Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.
allergy-snomed { "coding": [ { "system": "http://snomed.info/sct", "code": "227493005", "display": "Cashew nuts" } ], "text": "Cashews" } Mappings
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patient | S Σ I | 1..1 | Reference(Profile: Patient) | 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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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 | There are no (further) constraints on this element Element idAllergyIntolerance.onset[x] When allergy or intolerance was identified DefinitionEstimated or actual date, date-time, or age when allergy or intolerance was identified.
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onsetDateTime | dateTime | Data type | ||
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) | 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 | Σ I | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | 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 | 1..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..* | CodeableConceptBinding | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation Clinical symptoms/signs associated with the Event Alternate namesSymptoms, Signs DefinitionClinical symptoms and/or signs that are observed or associated with the adverse reaction event. 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. 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 | 0..1 | dateTime | Element idAllergyIntolerance.reaction.onset Onset of the particular reaction (not of the actual allergy) DefinitionRecord of the date and/or time of the onset of the Reaction.
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severity | 0..1 | codeBinding | Element idAllergyIntolerance.reaction.severity Severity of the particular reaction (not of the actual allergy) 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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Hybrid
AllergyIntolerance | 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 DefinitionThe US Core Allergies Profile is based upon the core FHIR AllergyIntolerance Resource and created to meet the 2015 Edition Common Clinical Data Set 'Medical allergies' requirements. 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 | 1..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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id | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.meta.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.meta.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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versionId | Σ | 0..1 | id | There are no (further) constraints on this element Element idAllergyIntolerance.meta.versionId Version specific identifier DefinitionThe version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted. The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
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lastUpdated | Σ | 0..1 | instant | There are no (further) constraints on this element Element idAllergyIntolerance.meta.lastUpdated When the resource version last changed DefinitionWhen the resource last changed - e.g. when the version changed. This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.
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meta-source | Σ | 1..1 | uri | Element idAllergyIntolerance.meta.source:meta-source uri of the data source DefinitionTypically the data owner's URL followed by a source/file description mandatory for all resources in bWell's FHIR Server In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
example of meta.source https://www.icanbwell.com/provider-directory Mappings
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profile | Σ | 0..* | canonical(StructureDefinition) | There are no (further) constraints on this element Element idAllergyIntolerance.meta.profile Profiles this resource claims to conform to DefinitionA list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url. It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set. canonical(StructureDefinition) Constraints
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meta-security | Σ | 1..* | CodingBinding | Element idAllergyIntolerance.meta.security:meta-security security tags representing the data's owner, vendor, and accessibility Definitiondata owner: data vendor: data access: /owner & /access are mandatory for all resources in bWell's FHIR Server The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored. Security Labels from the Healthcare Privacy and Security Classification System.
example of data owner security tag { "system": "https://www.icanbwell.com/owner", "code": "bwell" } example of data access security tag { "system": "https://www.icanbwell.com/access", "code": "bwell" } example of data vendor security tag { "system": "https://www.icanbwell.com/vendor", "code": "bwell" } Mappings
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tag | Σ | 0..* | Coding | There are no (further) constraints on this element Element idAllergyIntolerance.meta.tag Tags applied to this resource DefinitionTags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource. The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored. Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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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 | There are no (further) constraints on this element 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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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 | Element idAllergyIntolerance.identifier a value to identify the resource by 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. Unordered, Open, by slice by types Constraints
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(All Slices) | There are no (further) constraints on this element | |||
id | 1..1 | string | Element idAllergyIntolerance.identifier.id set case-by-case 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.identifier.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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use | Σ ?! | 0..1 | codeBinding | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.use usual | official | temp | secondary | old (If known) DefinitionThe purpose of this identifier. Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Identifies the purpose for this identifier, if known .
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type | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.type Description of identifier DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Allows users to make use of identifiers when the identifier system is not known. This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
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system | Σ | 0..1 | uri | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.system The namespace for the identifier value DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique. There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Identifier.system is always case sensitive.
General http://www.acme.com/identifiers/patient Mappings
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value | Σ | 0..1 | string | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.value The value that is unique DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system. If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
General 123456 Mappings
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period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.period Time period when id is/was valid for use DefinitionTime period during which identifier is/was valid for use. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
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assigner | Σ I | 0..1 | Reference(Organization) | There are no (further) constraints on this element Element idAllergyIntolerance.identifier.assigner Organization that issued id (may be just text) DefinitionOrganization that issued/manages the identifier. The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
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clinicalStatus | S Σ ?! I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idAllergyIntolerance.clinicalStatus active | inactive | resolved DefinitionThe clinical status of the allergy or intolerance. Refer to discussion if clincalStatus is missing data. The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity. The clinical status of the allergy or intolerance.
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verificationStatus | S Σ ?! I | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idAllergyIntolerance.verificationStatus unconfirmed | confirmed | refuted | entered-in-error DefinitionAssertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product). The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity. Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
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type | 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 | 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 | CodeableConceptBinding | Element idAllergyIntolerance.code The allergen Alternate namesCode DefinitionCode 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"). 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. 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, UNII, and ATC. 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. Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.
allergy-snomed { "coding": [ { "system": "http://snomed.info/sct", "code": "227493005", "display": "Cashew nuts" } ], "text": "Cashews" } Mappings
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patient | S Σ I | 1..1 | Reference(Profile: Patient) | 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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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 | There are no (further) constraints on this element Element idAllergyIntolerance.onset[x] When allergy or intolerance was identified DefinitionEstimated or actual date, date-time, or age when allergy or intolerance was identified.
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onsetDateTime | dateTime | Data type | ||
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) | 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 | Σ I | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | 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 | 1..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..* | CodeableConceptBinding | There are no (further) constraints on this element Element idAllergyIntolerance.reaction.manifestation Clinical symptoms/signs associated with the Event Alternate namesSymptoms, Signs DefinitionClinical symptoms and/or signs that are observed or associated with the adverse reaction event. 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. 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 | 0..1 | dateTime | Element idAllergyIntolerance.reaction.onset Onset of the particular reaction (not of the actual allergy) DefinitionRecord of the date and/or time of the onset of the Reaction.
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severity | 0..1 | codeBinding | Element idAllergyIntolerance.reaction.severity Severity of the particular reaction (not of the actual allergy) 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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Examples:
{ "resourceType": "AllergyIntolerance", "id": "example-allergy-intolerance", "clinicalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical", "code": "active", "display": "Active" } ] }, "verificationStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification", "code": "confirmed", "display": "Confirmed" } ] }, "type": "allergy", "category": [ "food" ], "criticality": "high", "code": { "coding": [ { "system": "http://snomed.info/sct", "code": "227493005", "display": "Cashew nuts" } ] }, "patient": { "reference": "Patient/bwell-1111111" }, "onsetDateTime": "2004", "recordedDate": "2014-10-09T14:58:00+11:00", "recorder": { "reference": "Patient/bwell-1111111" }, "asserter": { "reference": "Patient/bwell-1111111" }, "lastOccurrence": "2012-06", "reaction": [ { "id": "anaphylaxis", "manifestation": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "39579001", "display": "Anaphylactic reaction" } ] } ], "description": "Challenge Protocol. Severe reaction to subcutaneous cashew extract. Epinephrine administered", "onset": "2012-06-12", "severity": "severe" }, { "manifestation": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "64305001", "display": "Urticaria" } ] } ], "onset": "2004", "severity": "moderate", "note": [ { "text": "The patient reports that the onset of urticaria was within 15 minutes of eating cashews." } ] } ] }