CA Core+
1.2.0-dft 
1.2.0-DFT - The specification is version 1.2.0-DFT of CA Core+ For a full list of available versions, see the Directory of published versions
AllergyIntolerance (CA-Core)
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Links
Profile
Derived from
http://hl7.org/fhir/StructureDefinition/AllergyIntolerance
Examples
Description
This profile applies constraints to the AllergyIntolerance resource for CA Core+ to support the documentation of allergies and intolerances in the pan-Canadian context. It includes expectations for coded substances, reactions, and severity.
References to this resource
CFMM: 2
Resource Content
| AllergyIntoleranceCACore (AllergyIntolerance) | C | AllergyIntolerance | |
| id | Σ | 0..1 | id |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| abatement | C | 0..1 | Extension(AgedateTimePeriodRangestring) |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | Σ | 0..* | Identifier |
| clinicalStatus | Σ ?! C | 0..1 | CodeableConceptBinding |
| verificationStatus | Σ ?! C | 0..1 | CodeableConceptBinding |
| type | Σ | 0..1 | codeBinding |
| category | Σ | 0..* | codeBinding |
| criticality | Σ | 0..1 | codeBinding |
| code | O Σ | 0..1 | CodeableConceptCACoreBinding |
| patient | Σ C | 1..1 | Reference(PatientCACore) |
| encounter | C | 0..1 | Reference(EncounterCACore) |
| onset[x] | 0..1 | ||
| onsetAge | Age | ||
| onsetPeriod | Period | ||
| onsetRange | Range | ||
| onsetString | string | ||
| onsetDateTime | 0..1 | dateTime | |
| recordedDate | 0..1 | dateTime | |
| recorder | C | 0..1 | Reference(PatientCACore | PractitionerCACore | PractitionerRoleCACore | RelatedPerson) |
| asserter | Σ C | 0..1 | Reference(PatientCACore | PractitionerCACore | PractitionerRoleCACore | RelatedPerson) |
| lastOccurrence | 0..1 | dateTime | |
| note | 0..* | Annotation | |
| reaction | O | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| substance | 0..1 | CodeableConcept | |
| manifestation | O | 1..* | CodeableConceptCACoreBinding |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| coding | O Σ | 0..* | CodingCACore |
| text | Σ | 0..1 | string |
| description | 0..1 | string | |
| onset | 0..1 | dateTime | |
| severity | 0..1 | codeBinding | |
| exposureRoute | 0..1 | CodeableConcept | |
| note | 0..* | Annotation |
| AllergyIntoleranceCACore (AllergyIntolerance) | C | AllergyIntolerance | |
| id | Σ | 0..1 | id |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| abatement | C | 0..1 | Extension(AgedateTimePeriodRangestring) |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | Σ | 0..* | Identifier |
| clinicalStatus | Σ ?! C | 0..1 | CodeableConceptBinding |
| verificationStatus | Σ ?! C | 0..1 | CodeableConceptBinding |
| type | Σ | 0..1 | codeBinding |
| category | Σ | 0..* | codeBinding |
| criticality | Σ | 0..1 | codeBinding |
| code | O Σ | 0..1 | CodeableConceptCACoreBinding |
| patient | Σ C | 1..1 | Reference(PatientCACore) |
| encounter | C | 0..1 | Reference(EncounterCACore) |
| onset[x] | 0..1 | ||
| onsetAge | Age | ||
| onsetPeriod | Period | ||
| onsetRange | Range | ||
| onsetString | string | ||
| onsetDateTime | 0..1 | dateTime | |
| recordedDate | 0..1 | dateTime | |
| recorder | C | 0..1 | Reference(PatientCACore | PractitionerCACore | PractitionerRoleCACore | RelatedPerson) |
| asserter | Σ C | 0..1 | Reference(PatientCACore | PractitionerCACore | PractitionerRoleCACore | RelatedPerson) |
| lastOccurrence | 0..1 | dateTime | |
| note | 0..* | Annotation | |
| reaction | O | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| substance | 0..1 | CodeableConcept | |
| manifestation | O | 1..* | CodeableConceptCACoreBinding |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| coding | O Σ | 0..* | CodingCACore |
| text | Σ | 0..1 | string |
| description | 0..1 | string | |
| onset | 0..1 | dateTime | |
| severity | 0..1 | codeBinding | |
| exposureRoute | 0..1 | CodeableConcept | |
| note | 0..* | Annotation |
</extension>
<url value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/allergyintolerance-ca-core" />
</telecom>
</telecom>
</contact>
<description value="This profile applies constraints to the AllergyIntolerance resource for CA Core+ to support the documentation of allergies and intolerances in the pan-Canadian context. It includes expectations for coded substances, reactions, and severity." />
</jurisdiction>
<copyright value="Copyright © 2025+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." />
<comment value="Mapping for AllergyIntoleranceCACore to Canadian Core Data for Interoperability (CACDI)." />
</mapping>
<definition value="Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance." />
<comment value="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." />
</base>
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
</constraint>
<human value="If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource" />
<expression value="contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
</constraint>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
</constraint>
<human value="AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error." />
<expression value="verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()" />
<xpath value="f:verificationStatus/f:coding/f:code/@value='entered-in-error' or exists(f:clinicalStatus)" />
</constraint>
<human value="AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error" />
<expression value="verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()" />
<xpath value="not(f:verificationStatus/f:coding/f:code/@value='entered-in-error') or not(exists(f:clinicalStatus))" />
</constraint>
</mapping>
</mapping>
</element>
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
</base>
</extension>
</type>
</constraint>
</mapping>
</element>
<definition value="The 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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="A 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." />
<comment value="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." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
</mapping>
</element>
<comment value="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)." />
</base>
</type>
</constraint>
</extension>
</extension>
</binding>
</mapping>
</element>
<definition value="A 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." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</mapping>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="May 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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</element>
<definition value="The date or estimated date that the allergy or intolerance resolved. This is called abatement because of the many overloaded connotations associated with resolution." />
<comment value="Age is generally used when the patient reports an age at which the allergy or intolerance abated. If there is no abatement element, the clinicalStatus can be used to convey whether allergy or intolerance has resolved or not. When abatementString exists, it conveys that the allergy or intolerance is abated." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
</mapping>
</mapping>
</element>
<definition value="Business 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." />
<comment value="This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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." />
<requirements value="Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers." />
</base>
</type>
</constraint>
</mapping>
</mapping>
<map value="II - 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]" />
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="Refer to [discussion](extensibility.html#Special-Case) if clincalStatus is missing data.\nThe 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." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as no longer active." />
</extension>
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value" />
</mapping>
</element>
<definition value="Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product)." />
<comment value="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." />
</base>
</type>
</constraint>
<isModifierReason value="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." />
</extension>
<description value="Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance." />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value" />
</mapping>
</element>
<definition value="Identification of the underlying physiological mechanism for the reaction risk." />
<comment value="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." />
</base>
</type>
</constraint>
</extension>
<description value="Identification of the underlying physiological mechanism for a Reaction Risk." />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="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](search.html) 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." />
</base>
</type>
</constraint>
</extension>
<description value="Category of an identified substance associated with allergies or intolerances." />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance." />
<comment value="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." />
</base>
</type>
</constraint>
</extension>
<description value="Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance." />
</binding>
</mapping>
</mapping>
</mapping>
<map value="inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]" />
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text." />
<comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
</base>
<profile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core" />
</type>
</constraint>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<description value="Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies." />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode" />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="substance/product:\n\n.participation[typeCode=CAGNT].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]\n\nnegated/excluded substance/product:\n\n.participation[typeCode=CAGNT, negationInd=true].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]\n\npositive or negated/excluded condition/situation:\n\nObservation.code=ASSERTION; Observation.value" />
</mapping>
</mapping>
</element>
<comment value="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." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
</type>
</constraint>
<expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="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." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/encounter-ca-core" />
</type>
</constraint>
<expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="Estimated or actual date, date-time, or age when allergy or intolerance was identified." />
</base>
</type>
</type>
</type>
</type>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Estimated or actual date, date-time, or age when allergy or intolerance was identified." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="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." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
</type>
</constraint>
<expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<comment value="The recorder takes responsibility for the content, but can reference the source from where they got it." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
</type>
</constraint>
<expression value="reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))" />
<xpath value="not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])" />
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Represents the date and/or time of the last known occurrence of a reaction event." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
<map value="outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)].effectiveTime" />
</mapping>
</element>
<definition value="Additional narrative about the propensity for the Adverse Reaction, not captured in other fields." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="Details about each adverse reaction event linked to exposure to the identified substance." />
</base>
</type>
</constraint>
</mapping>
<map value="outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)]" />
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</element>
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</mapping>
</element>
<short value="Specific substance or pharmaceutical product considered to be responsible for event" />
<definition value="Identification 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." />
<comment value="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'." />
</base>
</type>
</constraint>
</extension>
<description value="Codes defining the type of the substance (including pharmaceutical products)." />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].participation[typeCode=CSM].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]" />
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text." />
<comment value="Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination." />
</base>
<profile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core" />
</type>
</constraint>
</extension>
<description value="Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event." />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<comment value="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." />
<requirements value="Allows for alternative encodings within a code system, and translations to other code systems." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</extension>
<definition value="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." />
<requirements value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Text description about the reaction as a whole, including details of the manifestation if required." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Clinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations." />
<comment value="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." />
</base>
</type>
</constraint>
</extension>
<description value="Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations." />
</binding>
</mapping>
<map value="inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]" />
</mapping>
</element>
<definition value="Identification of the route by which the subject was exposed to the substance." />
<comment value="Coding of the route of exposure with a terminology should be used wherever possible." />
</base>
</type>
</constraint>
</extension>
<description value="A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject." />
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
<map value="outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].routeCode" />
</mapping>
</element>
<definition value="Additional text about the adverse reaction event not captured in other fields." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</snapshot>
</discriminator>
</slicing>
</element>
</type>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<profile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core" />
</type>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode" />
</binding>
</mapping>
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
</type>
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/encounter-ca-core" />
</type>
</element>
</discriminator>
</slicing>
</element>
</type>
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
</type>
</element>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core" />
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
</type>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<profile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core" />
</type>
</binding>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</differential>
</StructureDefinition>
{
],
{
{
},
{
}
]
}
],
"description": "This profile applies constraints to the AllergyIntolerance resource for CA Core+ to support the documentation of allergies and intolerances in the pan-Canadian context. It includes expectations for coded substances, reactions, and severity.",
],
"copyright": "Copyright © 2025+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
{
"comment": "Mapping for AllergyIntoleranceCACore to Canadian Core Data for Interoperability (CACDI)."
}
],
{
"definition": "Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.",
"comment": "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.",
"Allergy",
"Intolerance",
"Adverse Reaction"
],
},
{
},
{
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
},
{
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource",
"expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
},
{
{
},
{
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
},
{
},
{
"human": "AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error.",
"expression": "verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()",
"xpath": "f:verificationStatus/f:coding/f:code/@value='entered-in-error' or exists(f:clinicalStatus)",
},
{
"human": "AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error",
"expression": "verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()",
"xpath": "not(f:verificationStatus/f:coding/f:code/@value='entered-in-error') or not(exists(f:clinicalStatus))",
}
],
{
},
{
}
]
},
{
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
},
{
{
}
],
}
],
"ele-1"
],
{
}
],
]
},
{
"definition": "The 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.",
},
],
"ele-1"
],
{
}
],
]
},
{
"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. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment": "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.",
},
],
"ele-1"
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
]
},
{
"comment": "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).",
},
],
"ele-1"
],
{
}
],
{
},
{
}
],
},
]
},
{
"definition": "A 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.",
"comment": "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.",
"narrative",
"html",
"xhtml",
"display"
],
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
}
]
},
{
"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.",
"comment": "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.",
"inline resources",
"anonymous resources",
"contained resources"
],
},
],
]
},
{
],
},
"definition": "May 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.",
"comment": "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.",
"extensions",
"user content"
],
},
],
"ele-1"
],
{
},
{
}
],
]
},
{
"definition": "The date or estimated date that the allergy or intolerance resolved. This is called abatement because of the many overloaded connotations associated with resolution.",
"comment": "Age is generally used when the patient reports an age at which the allergy or intolerance abated. If there is no abatement element, the clinicalStatus can be used to convey whether allergy or intolerance has resolved or not. When abatementString exists, it conveys that the allergy or intolerance is abated.",
"extensions",
"user content"
],
},
{
"http://hl7.org/fhir/StructureDefinition/allergyintolerance-abatement"
]
}
],
"ele-1"
],
{
},
{
}
],
]
},
{
],
},
"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 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"extensions",
"user content"
],
},
],
"ele-1"
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
]
},
{
"definition": "Business 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.",
"comment": "This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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.",
"requirements": "Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers.",
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
"map": "II - 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]"
},
{
},
{
},
{
},
{
}
]
},
{
"comment": "Refer to [discussion](extensibility.html#Special-Case) if clincalStatus is missing data.\nThe 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.",
},
],
"ele-1",
"ait-1",
"ait-2"
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as no longer active.",
{
}
],
},
{
},
{
},
{
},
{
},
{
},
{
"map": "Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code=\"clinicalStatus\", moodCode=EVN].value"
}
]
},
{
"definition": "Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).",
"comment": "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.",
},
],
"ele-1",
"ait-1",
"ait-2"
],
{
}
],
"isModifierReason": "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.",
{
}
],
"description": "Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.",
},
{
},
{
},
{
},
{
},
{
},
{
"map": "Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code=\"verificationStatus\", moodCode=EVN].value"
}
]
},
{
"comment": "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.",
"Category",
"Class"
],
},
],
"ele-1"
],
{
}
],
{
}
],
},
{
},
{
},
{
},
{
}
]
},
{
"comment": "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](search.html) 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",
"Type",
"Reaction Type",
"Class"
],
},
],
"ele-1"
],
{
}
],
{
}
],
},
{
},
{
},
{
},
{
}
]
},
{
"definition": "Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance.",
"comment": "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.",
"Severity",
"Seriousness",
"Contra-indication",
"Risk"
],
},
],
"ele-1"
],
{
}
],
{
}
],
"description": "Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.",
},
{
},
{
},
{
},
{
"map": "inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]"
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"Code"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core"
]
}
],
"ele-1"
],
{
}
],
{
},
{
{
},
{
},
{
}
],
},
{
{
},
{
},
{
}
],
},
{
{
},
{
},
{
}
],
}
],
"description": "Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode"
},
{
},
{
},
{
},
{
},
{
},
{
},
{
"map": "substance/product:\n\n.participation[typeCode=CAGNT].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]\n\nnegated/excluded substance/product:\n\n.participation[typeCode=CAGNT, negationInd=true].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]\n\npositive or negated/excluded condition/situation:\n\nObservation.code=ASSERTION; Observation.value"
},
{
}
]
},
{
"comment": "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.",
"Patient"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"comment": "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.",
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/encounter-ca-core"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
}
]
},
{
},
"definition": "Estimated or actual date, date-time, or age when allergy or intolerance was identified.",
},
{
},
{
},
{
},
{
},
{
}
],
"ele-1"
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "Estimated or actual date, date-time, or age when allergy or intolerance was identified.",
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "The recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date.",
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"comment": "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.",
"Author"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
}
]
},
{
"comment": "The recorder takes responsibility for the content, but can reference the source from where they got it.",
"Source",
"Informant"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
],
"ele-1"
],
{
},
{
"expression": "reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
}
],
{
},
{
},
{
},
{
},
{
}
]
},
{
"comment": "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.",
},
],
"ele-1"
],
{
}
],
{
},
{
"map": "outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)].effectiveTime"
}
]
},
{
"definition": "Additional narrative about the propensity for the Adverse Reaction, not captured in other fields.",
"comment": "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.",
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"definition": "Details about each adverse reaction event linked to exposure to the identified substance.",
},
],
"ele-1"
],
{
}
],
{
},
{
"map": "outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)]"
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"extensions",
"user content"
],
},
],
"ele-1"
],
{
},
{
}
],
]
},
{
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
"ele-1"
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
"definition": "Identification 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.",
"comment": "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'.",
},
],
"ele-1"
],
{
}
],
{
}
],
},
{
},
{
},
{
},
{
},
{
"map": "outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].participation[typeCode=CSM].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]"
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"definition": "A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.",
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"Symptoms",
"Signs"
],
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core"
]
}
],
"ele-1"
],
{
}
],
{
}
],
"description": "Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.",
},
{
},
{
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"comment": "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.",
"extensions",
"user content"
],
},
],
"ele-1"
],
{
},
{
}
],
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"comment": "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.",
"requirements": "Allows for alternative encodings within a code system, and translations to other code systems.",
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/coding-ca-core"
]
}
],
"ele-1"
],
{
}
],
{
},
{
},
{
},
{
},
{
},
{
},
{
}
]
},
{
{
}
],
"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.",
"requirements": "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.",
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "Text description about the reaction as a whole, including details of the manifestation if required.",
"comment": "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.",
"Narrative",
"Text"
],
},
],
"ele-1"
],
{
}
],
]
},
{
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
}
]
},
{
"definition": "Clinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations.",
"comment": "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.",
},
],
"ele-1"
],
{
}
],
{
}
],
"description": "Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.",
},
{
},
{
"map": "inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]"
}
]
},
{
},
],
"ele-1"
],
{
}
],
{
}
],
"description": "A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.",
},
{
},
{
},
{
},
{
},
{
}
]
},
{
"comment": "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.",
},
],
"ele-1"
],
{
}
],
{
},
{
},
{
},
{
}
]
}
]
},
{
}
},
{
{
"http://hl7.org/fhir/StructureDefinition/allergyintolerance-abatement"
]
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core"
]
}
],
{
{
},
{
},
{
}
],
},
{
{
},
{
},
{
}
],
},
{
{
},
{
},
{
}
],
}
],
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode"
},
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core"
]
}
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/encounter-ca-core"
]
}
]
},
{
}
},
{
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
]
},
{
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitioner-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/practitionerRole-ca-core",
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/codeableconcept-ca-core"
]
}
],
},
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
}
]
}
}
Terminology bindings
| Path | Conformance | ValueSet |
|---|---|---|
| AllergyIntolerance.code | preferred | https://fhir.infoway-inforoute.ca/ValueSet/pharmaceuticalbiologicproductandsubstancecode |
| AllergyIntolerance.reaction.manifestation | preferred | https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode |
Additional Terminology Bindings
These bindings may be used in lieu of the primary bindings in the table above.
| Path | Conformance | AdditionalValueSet |
|---|---|---|
| AllergyIntolerance.code | candidate | https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct |
Mappings to CACDI
The following tables list how the data elements from CA Core+ map to CACDI. For more information visit Mapping Logic.
| FHIR Profile Element | CACDI Element(s) |
|---|---|
| AllergyIntolerance.code | Allergy or Intolerance |
| AllergyIntolerance.reaction.manifestation | Allergy or Intolerance Reaction |
Constraints
The following table lists constraints (from differential).