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This version of the UK Core is for C&TA Sprint 7 Review.
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StructureDefinition-UKCore-AllergyIntolerance

Canonical_URL	Current_Version	Last_Updated	Description
https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntolerance	2.4.0	2022-12-16	This profile defines the UK constraints and extensions on the International FHIR resource AllergyIntolerance.

Profile_Purpose
This profile allows a record of a clinical assessment of an allergy or intolerance; a propensity, or a potential risk to an individual, to have an adverse reaction on future exposure to the specified substance, or class of substance. Where a propensity is identified, to record information or evidence about a reaction event that is characterised by any harmful or undesirable physiological response that is specific to the individual and triggered by exposure of an individual to the identified substance or class of substance. Substances include but are not limited to a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings. This resource is used to record physical conditions. It SHALL NOT be used to record preferences for or against types of treatment, for example on religious grounds. For such use cases consider the use of the FHIR Consent resource.

Profile_Purpose

This profile allows a record of a clinical assessment of an allergy or intolerance; a propensity, or a potential risk to an individual, to have an adverse reaction on future exposure to the specified substance, or class of substance.

Where a propensity is identified, to record information or evidence about a reaction event that is characterised by any harmful or undesirable physiological response that is specific to the individual and triggered by exposure of an individual to the identified substance or class of substance.

Substances include but are not limited to a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.

This resource is used to record physical conditions. It SHALL NOT be used to record preferences for or against types of treatment, for example on religious grounds. For such use cases consider the use of the FHIR Consent resource.

AllergyIntolerance	I		AllergyIntolerance	There are no (further) constraints on this element Element Id AllergyIntolerance Short description Allergy or Intolerance (generally: Risk of adverse reaction to a substance) Alternate names Allergy, Intolerance, Adverse Reaction Definition Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance. Comments 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. Data Type AllergyIntolerance Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `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()` dom-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` ait-1:AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. `verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()` ait-2:AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error `verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()` Mappings rim:Entity. Role, or Act rim:Observation[classCode=OBS, moodCode=EVN]
extension	I	0..*	Extension	Element Id AllergyIntolerance.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the 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. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
evidence	I	0..*	Extension(Reference(UK Core DiagnosticReport))	Element Id AllergyIntolerance.extension:evidence Short description A reference to results of investigations that confirmed the certainty of the diagnosis. Alternate names extensions, user content Definition A reference to results of investigations that confirmed the certainty of the diagnosis. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(Reference(UK Core DiagnosticReport)) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element Id AllergyIntolerance.identifier Short description External ids for this item 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. Requirements Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers. Comments 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. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: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] servd:Identifier w5:FiveWs.identifier v2:IAM-7 rim:id
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.identifier.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments 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. Data Type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id AllergyIntolerance.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements 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. Comments Identifier.system is always case sensitive. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments 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. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id AllergyIntolerance.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments 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. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(UK Core Organization)	Element Id AllergyIntolerance.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments 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. Data Type Reference(UK Core Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
clinicalStatus	Σ ?! I	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.clinicalStatus Short description active \| inactive \| resolved Definition The clinical status of the allergy or intolerance. Comments 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. Data Type CodeableConcept Binding The clinical status of the allergy or intolerance. AllergyIntoleranceClinicalStatusCodes (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.status rim:Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
extension	I	0..*	Extension	Element Id AllergyIntolerance.clinicalStatus.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
allergyIntoleranceEnd	I	0..1	Extension(Complex)	Element Id AllergyIntolerance.clinicalStatus.extension:allergyIntoleranceEnd Short description Supports the date when the allergy or intolerance was no longer valid, and/or, the reason why the allergy or intolerance is no longer valid. Alternate names extensions, user content Definition Supports the date when the allergy or intolerance was no longer valid, and/or, the reason why the allergy or intolerance is no longer valid. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data Type Extension(Complex) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1:Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim:n/a rim:N/A
coding	Σ	0..*	Coding	There are no (further) constraints on this element Element Id AllergyIntolerance.clinicalStatus.coding Short description Code defined by a terminology system Definition A reference to a code defined by a terminology system. Requirements Allows for alternative encodings within a code system, and translations to other code systems. Comments Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true. Data Type Coding Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim:CV orim:fhir:Coding rdfs:subClassOf dt:CDCoding v2:CE.1-8, CE.10-22 rim:union(., ./translation) orim:fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
text	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.clinicalStatus.text Short description Plain text representation of the concept Definition A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. 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. Comments Very often the text is the same as a displayName of one of the codings. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE.9. But note many systems use CE.2 for this rim:./originalText[mediaType/code="text/plain"]/data orim:fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
verificationStatus	Σ ?! I	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.verificationStatus Short description unconfirmed \| confirmed \| refuted \| entered-in-error Definition Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product). Comments 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. Data Type CodeableConcept Binding Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance. AllergyIntoleranceVerificationStatusCodes (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.status rim:Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
type	Σ	0..1	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.type Short description allergy \| intolerance - Underlying mechanism (if known) Alternate names Category, Class Definition Identification of the underlying physiological mechanism for the reaction risk. Comments 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. Data Type code Binding Identification of the underlying physiological mechanism for a Reaction Risk. AllergyIntoleranceType (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.class v2:IAM-9 rim:code
category	Σ	0..*	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.category Short description food \| medication \| environment \| biologic Alternate names Category, Type, Reaction Type, Class Definition Category of the identified substance. Comments 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. Data Type code Binding Category of an identified substance associated with allergies or intolerances. AllergyIntoleranceCategory (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.class v2:AL1-2 rim:value < IntoleranceValue (Agent)
criticality	Σ	0..1	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.criticality Short description low \| high \| unable-to-assess Alternate names Severity, Seriousness, Contra-indication, Risk Definition Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance. Comments 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. Data Type code Binding Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance. AllergyIntoleranceCriticality (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.grade v2:AL1-4 rim:inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]
code	Σ	1..1	CodeableConceptBinding	Element Id AllergyIntolerance.code Short description Code that identifies the allergy or intolerance Alternate names Code Definition Code for an allergy or intolerance statement (either a positive or a negated/excluded statement). This may be a code for a substance or pharmaceutical product that is considered to be responsible for the adverse reaction risk (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a negated/excluded code for a specific substance or class (e.g., "No latex allergy") or a general or categorical negated statement (e.g., "No known allergy", "No known drug allergies"). 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. Comments 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. Data Type CodeableConcept Binding Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies. UKCoreAllergyCode (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD w5:FiveWs.what[x] v2:AL1-3 / IAM-3 rim:substance/product: .participation[typeCode=CAGNT].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType] negated/excluded substance/product: .participation[typeCode=CAGNT, negationInd=true].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType] positive or negated/excluded condition/situation: Observation.code=ASSERTION; Observation.value
patient	Σ I	1..1	Reference(UK Core Patient)	Element Id AllergyIntolerance.patient Short description Who the sensitivity is for Alternate names Patient Definition The patient who has the allergy or intolerance. Comments 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. Data Type Reference(UK Core Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.subject[x] v2:(PID-3) rim:.participation[typeCode=SBJ].role[classCode=PAT] w5:FiveWs.subject
reference	Σ I	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data Type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: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] servd:Identifier rim:.identifier
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.identifier.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments 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. Data Type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements 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. Comments Identifier.system is always case sensitive. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments 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. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments 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. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(UK Core Organization)	Element Id AllergyIntolerance.patient.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments 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. Data Type Reference(UK Core Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.patient.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
encounter	I	0..1	Reference(UK Core Encounter)	Element Id AllergyIntolerance.encounter Short description Encounter when the allergy or intolerance was asserted Definition The encounter when the allergy or intolerance was asserted. Comments 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. Data Type Reference(UK Core Encounter) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.context rim:.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
reference	Σ I	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data Type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: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] servd:Identifier rim:.identifier
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.identifier.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments 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. Data Type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements 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. Comments Identifier.system is always case sensitive. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments 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. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments 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. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(UK Core Organization)	Element Id AllergyIntolerance.encounter.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments 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. Data Type Reference(UK Core Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.encounter.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
onset[x]		0..1		There are no (further) constraints on this element Element Id AllergyIntolerance.onset[x] Short description When allergy or intolerance was identified Definition Estimated or actual date, date-time, or age when allergy or intolerance was identified. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.init rim:effectiveTime.low
onsetDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
onsetAge			Age	There are no (further) constraints on this element Data Type Age
onsetPeriod			Period	There are no (further) constraints on this element Data Type Period
onsetRange			Range	There are no (further) constraints on this element Data Type Range
onsetString			string	There are no (further) constraints on this element Data Type string
recordedDate		0..1	dateTime	There are no (further) constraints on this element Element Id AllergyIntolerance.recordedDate Short description Date first version of the resource instance was recorded Definition The recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date. Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a w5:FiveWs.recorded v2:IAM-13 rim:.participation[typeCode=AUT].time
recorder	I	0..1	Reference(UK Core Practitioner \| UK Core PractitionerRole \| UK Core Patient \| UK Core RelatedPerson)	Element Id AllergyIntolerance.recorder Short description Who recorded the sensitivity Alternate names Author Definition Individual who recorded the record and takes responsibility for its content. Comments 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. Data Type Reference(UK Core Practitioner \| UK Core PractitionerRole \| UK Core Patient \| UK Core RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.author rim:.participation[typeCode=AUT].role
reference	Σ I	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data Type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: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] servd:Identifier rim:.identifier
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.identifier.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments 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. Data Type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements 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. Comments Identifier.system is always case sensitive. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments 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. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments 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. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(UK Core Organization)	Element Id AllergyIntolerance.recorder.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments 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. Data Type Reference(UK Core Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.recorder.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
asserter	Σ I	0..1	Reference(UK Core Patient \| UK Core RelatedPerson \| UK Core Practitioner \| UK Core PractitionerRole)	Element Id AllergyIntolerance.asserter Short description Source of the information about the allergy Alternate names Source, Informant Definition The source of the information about the allergy that is recorded. Comments The recorder takes responsibility for the content, but can reference the source from where they got it. Data Type Reference(UK Core Patient \| UK Core RelatedPerson \| UK Core Practitioner \| UK Core PractitionerRole) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.source v2:IAM-14 (if patient) / IAM-18 (if practitioner) rim:.participation[typeCode=INF].role
reference	Σ I	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data Type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: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] servd:Identifier rim:.identifier
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.identifier.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data Type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.identifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments 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. Data Type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:CX.5 rim:Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.identifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements 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. Comments Identifier.system is always case sensitive. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim:n/a v2:CX.4 / EI-2-4 rim:II.root or Role.id.root servd:./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.identifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments 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. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings rim:n/a v2:CX.1 / EI.1 rim:II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd:./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.identifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments 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. Data Type Period Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1:If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim:n/a v2:DR rim:IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2:CX.7 + CX.8 rim:Role.effectiveTime or implied by context servd:./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(UK Core Organization)	Element Id AllergyIntolerance.asserter.identifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments 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. Data Type Reference(UK Core Organization) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2:CX.4 / (CX.4,CX.9,CX.10) rim:II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd:./IdentifierIssuingAuthority
display	Σ	0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.asserter.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
lastOccurrence		0..1	dateTime	There are no (further) constraints on this element Element Id AllergyIntolerance.lastOccurrence Short description Date(/time) of last known occurrence of a reaction Definition Represents the date and/or time of the last known occurrence of a reaction event. Comments 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. Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)].effectiveTime
note		0..*	Annotation	There are no (further) constraints on this element Element Id AllergyIntolerance.note Short description Additional text not captured in other fields Definition Additional narrative about the propensity for the Adverse Reaction, not captured in other fields. Comments 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. Data Type Annotation Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act rim:subjectOf.observationEvent[code="annotation"].value
author[x]	Σ	0..1		There are no (further) constraints on this element Element Id AllergyIntolerance.note.author[x] Short description Individual responsible for the annotation Definition The individual responsible for making the annotation. Comments Organization is used when there's no need for specific attribution as to who made the comment. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act.participant[typeCode=AUT].role
authorString			string	Data Type string
authorReference			Reference(UK Core Practitioner \| UK Core Patient \| UK Core RelatedPerson \| UK Core Organization)	Data Type Reference(UK Core Practitioner \| UK Core Patient \| UK Core RelatedPerson \| UK Core Organization)
time	Σ	0..1	dateTime	There are no (further) constraints on this element Element Id AllergyIntolerance.note.time Short description When the annotation was made Definition Indicates when this particular annotation was made. Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act.effectiveTime
text	Σ	1..1	markdown	There are no (further) constraints on this element Element Id AllergyIntolerance.note.text Short description The annotation - text content (as markdown) Definition The text of the annotation in markdown format. Comments Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/ Data Type markdown Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act.text
reaction		0..*	BackboneElement	There are no (further) constraints on this element Element Id AllergyIntolerance.reaction Short description Adverse Reaction Events linked to exposure to substance Definition Details about each adverse reaction event linked to exposure to the identified substance. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)]
substance		0..1	CodeableConceptBinding	Element Id AllergyIntolerance.reaction.substance Short description Specific substance or pharmaceutical product considered to be responsible for event 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. Comments 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'. Data Type CodeableConcept Binding Codes defining the type of the substance (including pharmaceutical products). UKCoreAllergySubstance (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].participation[typeCode=CSM].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]
manifestation		1..*	CodeableConceptBinding	Element Id AllergyIntolerance.reaction.manifestation Short description Clinical symptoms/signs associated with the Event Alternate names Symptoms, Signs Definition Clinical symptoms and/or signs that are observed or associated with the adverse reaction event. Comments 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. Data Type CodeableConcept Binding Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event. UKCoreAllergyManifestation (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD v2:AL1-5 rim:code
description		0..1	string	There are no (further) constraints on this element Element Id AllergyIntolerance.reaction.description Short description Description of the event as a whole Alternate names Narrative, Text Definition Text description about the reaction as a whole, including details of the manifestation if required. Comments 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. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:text
onset		0..1	dateTime	There are no (further) constraints on this element Element Id AllergyIntolerance.reaction.onset Short description Date(/time) when manifestations showed Definition Record of the date and/or time of the onset of the Reaction. Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:AL1-6 rim:effectiveTime.low
severity		0..1	codeBinding	There are no (further) constraints on this element Element Id AllergyIntolerance.reaction.severity Short description mild \| moderate \| severe (of event as a whole) Definition Clinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations. Comments 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. Data Type code Binding Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations. AllergyIntoleranceSeverity (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]
exposureRoute		0..1	CodeableConceptBinding	Element Id AllergyIntolerance.reaction.exposureRoute Short description How the subject was exposed to the substance Definition Identification of the route by which the subject was exposed to the substance. Comments Coding of the route of exposure with a terminology should be used wherever possible. Data Type CodeableConcept Binding A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject. UKCoreSubstanceOrProductAdministrationRoute (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CE/CNE/CWE rim:CD orim:fhir:CodeableConcept rdfs:subClassOf dt:CD rim:outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].routeCode
note		0..*	Annotation	There are no (further) constraints on this element Element Id AllergyIntolerance.reaction.note Short description Text about event not captured in other fields Definition Additional text about the adverse reaction event not captured in other fields. Comments 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. Data Type Annotation Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act rim:subjectOf.observationEvent[code="annotation"].value
author[x]	Σ	0..1		There are no (further) constraints on this element Element Id AllergyIntolerance.reaction.note.author[x] Short description Individual responsible for the annotation Definition The individual responsible for making the annotation. Comments Organization is used when there's no need for specific attribution as to who made the comment. Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act.participant[typeCode=AUT].role
authorString			string	Data Type string
authorReference			Reference(UK Core Practitioner \| UK Core Patient \| UK Core RelatedPerson \| UK Core Organization)	Data Type Reference(UK Core Practitioner \| UK Core Patient \| UK Core RelatedPerson \| UK Core Organization)
time	Σ	0..1	dateTime	There are no (further) constraints on this element Element Id AllergyIntolerance.reaction.note.time Short description When the annotation was made Definition Indicates when this particular annotation was made. Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act.effectiveTime
text	Σ	1..1	markdown	There are no (further) constraints on this element Element Id AllergyIntolerance.reaction.note.text Short description The annotation - text content (as markdown) Definition The text of the annotation in markdown format. Comments Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/ Data Type markdown Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:N/A rim:Act.text

Table View

AllergyIntolerance		..
AllergyIntolerance.extension		0..
AllergyIntolerance.extension	Extension	0..
AllergyIntolerance.identifier		..
AllergyIntolerance.identifier.assigner	Reference(UK Core Organization)	..
AllergyIntolerance.clinicalStatus		..
AllergyIntolerance.clinicalStatus.extension		0..
AllergyIntolerance.clinicalStatus.extension	Extension	0..1
AllergyIntolerance.code		1..
AllergyIntolerance.patient	Reference(UK Core Patient)	..
AllergyIntolerance.patient.identifier		..
AllergyIntolerance.patient.identifier.assigner	Reference(UK Core Organization)	..
AllergyIntolerance.encounter	Reference(UK Core Encounter)	..
AllergyIntolerance.encounter.identifier		..
AllergyIntolerance.encounter.identifier.assigner	Reference(UK Core Organization)	..
AllergyIntolerance.recorder	Reference(UK Core Practitioner \| UK Core PractitionerRole \| UK Core Patient \| UK Core RelatedPerson)	..
AllergyIntolerance.recorder.identifier		..
AllergyIntolerance.recorder.identifier.assigner	Reference(UK Core Organization)	..
AllergyIntolerance.asserter	Reference(UK Core Patient \| UK Core RelatedPerson \| UK Core Practitioner \| UK Core PractitionerRole)	..
AllergyIntolerance.asserter.identifier		..
AllergyIntolerance.asserter.identifier.assigner	Reference(UK Core Organization)	..
AllergyIntolerance.note		..
AllergyIntolerance.note.author[x]	Reference(UK Core Practitioner \| UK Core Patient \| UK Core RelatedPerson \| UK Core Organization), string	..
AllergyIntolerance.reaction		..
AllergyIntolerance.reaction.substance		..
AllergyIntolerance.reaction.manifestation		..
AllergyIntolerance.reaction.exposureRoute		..
AllergyIntolerance.reaction.note		..
AllergyIntolerance.reaction.note.author[x]	Reference(UK Core Practitioner \| UK Core Patient \| UK Core RelatedPerson \| UK Core Organization), string	..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntolerance" />
    <version value="2.4.0" />
    <name value="UKCoreAllergyIntolerance" />
    <title value="UK Core AllergyIntolerance" />
    <status value="active" />
    <date value="2022-12-16" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [AllergyIntolerance](https://hl7.org/fhir/R4/AllergyIntolerance.html)." />
    <purpose value="This profile allows a record of a clinical assessment of an allergy or intolerance; a propensity, or a potential risk to an individual, to have an adverse reaction on future exposure to the specified substance, or class of substance. \n\nWhere a propensity is identified, to record information or evidence about a reaction event that is characterised by any harmful or undesirable physiological response that is specific to the individual and triggered by exposure of an individual to the identified substance or class of substance. \n\nSubstances 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. \n\nThis resource is used to record physical conditions. It SHALL NOT be used to record preferences for or against types of treatment, for example on religious grounds. For such use cases consider the use of the FHIR [Consent](https://hl7.org/fhir/R4/consent.html) resource." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <mapping>
        <identity value="rim" />
        <uri value="http://hl7.org/v3" />
        <name value="RIM Mapping" />
    </mapping>
    <mapping>
        <identity value="w5" />
        <uri value="http://hl7.org/fhir/fivews" />
        <name value="FiveWs Pattern Mapping" />
    </mapping>
    <mapping>
        <identity value="v2" />
        <uri value="http://hl7.org/v2" />
        <name value="HL7 v2 Mapping" />
    </mapping>
    <kind value="resource" />
    <abstract value="false" />
    <type value="AllergyIntolerance" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/AllergyIntolerance" />
    <derivation value="constraint" />
    <differential>
        <element id="AllergyIntolerance.extension">
            <path value="AllergyIntolerance.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <rules value="open" />
            </slicing>
            <min value="0" />
        </element>
        <element id="AllergyIntolerance.extension:evidence">
            <path value="AllergyIntolerance.extension" />
            <sliceName value="evidence" />
            <short value="A reference to results of investigations that confirmed the certainty of the diagnosis." />
            <min value="0" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence" />
            </type>
        </element>
        <element id="AllergyIntolerance.identifier.assigner">
            <path value="AllergyIntolerance.identifier.assigner" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
            </type>
        </element>
        <element id="AllergyIntolerance.clinicalStatus.extension">
            <path value="AllergyIntolerance.clinicalStatus.extension" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="url" />
                </discriminator>
                <rules value="open" />
            </slicing>
            <min value="0" />
        </element>
        <element id="AllergyIntolerance.clinicalStatus.extension:allergyIntoleranceEnd">
            <path value="AllergyIntolerance.clinicalStatus.extension" />
            <sliceName value="allergyIntoleranceEnd" />
            <min value="0" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="AllergyIntolerance.code">
            <path value="AllergyIntolerance.code" />
            <min value="1" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode" />
            </binding>
        </element>
        <element id="AllergyIntolerance.patient">
            <path value="AllergyIntolerance.patient" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" />
            </type>
        </element>
        <element id="AllergyIntolerance.patient.identifier.assigner">
            <path value="AllergyIntolerance.patient.identifier.assigner" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
            </type>
        </element>
        <element id="AllergyIntolerance.encounter">
            <path value="AllergyIntolerance.encounter" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter" />
            </type>
        </element>
        <element id="AllergyIntolerance.encounter.identifier.assigner">
            <path value="AllergyIntolerance.encounter.identifier.assigner" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
            </type>
        </element>
        <element id="AllergyIntolerance.recorder">
            <path value="AllergyIntolerance.recorder" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson" />
            </type>
        </element>
        <element id="AllergyIntolerance.recorder.identifier.assigner">
            <path value="AllergyIntolerance.recorder.identifier.assigner" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
            </type>
        </element>
        <element id="AllergyIntolerance.asserter">
            <path value="AllergyIntolerance.asserter" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole" />
            </type>
        </element>
        <element id="AllergyIntolerance.asserter.identifier.assigner">
            <path value="AllergyIntolerance.asserter.identifier.assigner" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
            </type>
        </element>
        <element id="AllergyIntolerance.note.author[x]">
            <path value="AllergyIntolerance.note.author[x]" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
            </type>
            <type>
                <code value="string" />
            </type>
        </element>
        <element id="AllergyIntolerance.reaction.substance">
            <path value="AllergyIntolerance.reaction.substance" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-AllergySubstance" />
            </binding>
        </element>
        <element id="AllergyIntolerance.reaction.manifestation">
            <path value="AllergyIntolerance.reaction.manifestation" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation" />
            </binding>
        </element>
        <element id="AllergyIntolerance.reaction.exposureRoute">
            <path value="AllergyIntolerance.reaction.exposureRoute" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute" />
            </binding>
        </element>
        <element id="AllergyIntolerance.reaction.note.author[x]">
            <path value="AllergyIntolerance.reaction.note.author[x]" />
            <type>
                <code value="Reference" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson" />
                <targetProfile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization" />
            </type>
            <type>
                <code value="string" />
            </type>
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-AllergyIntolerance",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntolerance",
    "version": "2.4.0",
    "name": "UKCoreAllergyIntolerance",
    "title": "UK Core AllergyIntolerance",
    "status": "active",
    "date": "2022-12-16",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [AllergyIntolerance](https://hl7.org/fhir/R4/AllergyIntolerance.html).",
    "purpose": "This profile allows a record of a clinical assessment of an allergy or intolerance; a propensity, or a potential risk to an individual, to have an adverse reaction on future exposure to the specified substance, or class of substance. \n\nWhere a propensity is identified, to record information or evidence about a reaction event that is characterised by any harmful or undesirable physiological response that is specific to the individual and triggered by exposure of an individual to the identified substance or class of substance. \n\nSubstances 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. \n\nThis resource is used to record physical conditions. It SHALL NOT be used to record preferences for or against types of treatment, for example on religious grounds. For such use cases consider the use of the FHIR [Consent](https://hl7.org/fhir/R4/consent.html) resource.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "mapping":  [
        {
            "identity": "rim",
            "uri": "http://hl7.org/v3",
            "name": "RIM Mapping"
        },
        {
            "identity": "w5",
            "uri": "http://hl7.org/fhir/fivews",
            "name": "FiveWs Pattern Mapping"
        },
        {
            "identity": "v2",
            "uri": "http://hl7.org/v2",
            "name": "HL7 v2 Mapping"
        }
    ],
    "kind": "resource",
    "abstract": false,
    "type": "AllergyIntolerance",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "AllergyIntolerance.extension",
                "path": "AllergyIntolerance.extension",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "url"
                        }
                    ],
                    "rules": "open"
                },
                "min": 0
            },
            {
                "id": "AllergyIntolerance.extension:evidence",
                "path": "AllergyIntolerance.extension",
                "sliceName": "evidence",
                "short": "A reference to results of investigations that confirmed the certainty of the diagnosis.",
                "min": 0,
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.identifier.assigner",
                "path": "AllergyIntolerance.identifier.assigner",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.clinicalStatus.extension",
                "path": "AllergyIntolerance.clinicalStatus.extension",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "url"
                        }
                    ],
                    "rules": "open"
                },
                "min": 0
            },
            {
                "id": "AllergyIntolerance.clinicalStatus.extension:allergyIntoleranceEnd",
                "path": "AllergyIntolerance.clinicalStatus.extension",
                "sliceName": "allergyIntoleranceEnd",
                "min": 0,
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "AllergyIntolerance.code",
                "path": "AllergyIntolerance.code",
                "min": 1,
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode"
                }
            },
            {
                "id": "AllergyIntolerance.patient",
                "path": "AllergyIntolerance.patient",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.patient.identifier.assigner",
                "path": "AllergyIntolerance.patient.identifier.assigner",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.encounter",
                "path": "AllergyIntolerance.encounter",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.encounter.identifier.assigner",
                "path": "AllergyIntolerance.encounter.identifier.assigner",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.recorder",
                "path": "AllergyIntolerance.recorder",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.recorder.identifier.assigner",
                "path": "AllergyIntolerance.recorder.identifier.assigner",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.asserter",
                "path": "AllergyIntolerance.asserter",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.asserter.identifier.assigner",
                "path": "AllergyIntolerance.asserter.identifier.assigner",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.note.author[x]",
                "path": "AllergyIntolerance.note.author[x]",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                        ]
                    },
                    {
                        "code": "string"
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.reaction.substance",
                "path": "AllergyIntolerance.reaction.substance",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AllergySubstance"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.manifestation",
                "path": "AllergyIntolerance.reaction.manifestation",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.exposureRoute",
                "path": "AllergyIntolerance.reaction.exposureRoute",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.note.author[x]",
                "path": "AllergyIntolerance.reaction.note.author[x]",
                "type":  [
                    {
                        "code": "Reference",
                        "targetProfile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson",
                            "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization"
                        ]
                    },
                    {
                        "code": "string"
                    }
                ]
            }
        ]
    }
}

Examples

Allergy - An example to illustrate an allergy to medication.
Example UKCore-AllergyIntolerance-Amoxicillin

Allergy entered in error - An example to illustrate an allergy which was entered in error and has been marked as ended.
Example UKCore-AllergyIntolerance-EnteredInError

Allergy evidence - An example to illustrate a reference to results of investigations that confirmed the certainty of the diagnosis for an allergy or intolerance.
Example UKCore-Extension-Evidence

Allergy List - An example to illustrate a list of allergies contained in a Bundle resource.
Example UKCore-Bundle-AllergyList

Usage

This Profile has the following derived profiles:

This Profile is referenced in the following Extensions:

This Profile is referenced in the following Profiles:

id	targetProfile
UKCore-FamilyMemberHistory	https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization; http://hl7.org/fhir/StructureDefinition/PlanDefinition; https://fhir.hl7.org.uk/StructureDefinition/UKCore-Questionnaire; http://hl7.org/fhir/StructureDefinition/ActivityDefinition; http://hl7.org/fhir/StructureDefinition/Measure; http://hl7.org/fhir/StructureDefinition/OperationDefinition; https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient; https://fhir.hl7.org.uk/StructureDefinition/UKCore-Condition; https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation; https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntolerance; https://fhir.hl7.org.uk/StructureDefinition/UKCore-QuestionnaireResponse; https://fhir.hl7.org.uk/StructureDefinition/UKCore-DiagnosticReport; https://fhir.hl7.org.uk/StructureDefinition/UKCore-DocumentReference; https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner; https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient; https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson; https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization

targetProfile

UKCore-FamilyMemberHistory

Example Usage Scenarios

The following are feasible use cases for the UK Core AllergyIntolerance profile:

Query for patient allergy information
Exchange patient allergy information within a FHIR Document or FHIR Message
Migration of allergies data between systems.

Profile Specific Implementation Guidance:

Use Case: Query

The query against a clinical system or shared record to return recorded allergies as AllergyIntolerance resources.

Returned results could be ordered by AllergyIntolerance.recordedDate and/or AllergyIntolerance.lastOccurrence.

Returned results MAY include multiple instances of the same allergy, as per the causative agent (AllergyIntolerance.code), but with different AllergyIntolerance.clinicalStatus values. The newer of such records either by AllergyIntolerance.recordedDate or AllergyIntolerance.lastOccurrence SHOULD be deemed the latest or current record of the allergy.

Use Case: Exchange

For when systems need to exchange allergy information within a point-to-point message. The AllergyIntolerance resources can be included within a FHIR Message (within the Bundle), or within a FHIR Document alongside other structured resources and text-based data.

Allergy information SHOULD NOT be duplicated between systems (and, in England, this aligns with the NHS Data Strategy). When exchanging allergies data between systems be mindful of whether the receiving system plans to persist the data. If persisted, processes SHALL be put in place to ensure the data is updated if/when the source record is updated.

Use Case: Migration

When allergy records are migrated between systems, the AllergyIntolerance resource could be used as a data migration standard.

Where migrated data is not coded, uses retired / invalidated codes, or coded with a terminology which cannot be mapped to SNOMED CT, then refer to the guidance on using degraded drug / non-drug allergy codes.

Minimum Viable Content

A minimum viable content that all provider and consumer systems SHALL support are the following elements.

Element	Reason
`AllergyIntolerance.clinicalStatus`	Defines whether the allergy or intolerance is active, inactive or resolved.
`AllergyIntolerance.verificationStatus`	Defines the assertion of the allergy or intolerance.
`AllergyIntolerance.code`	This code identifies the allergy or intolerance
`AllergyIntolerance.patient`	Links the allergy to the patient
`AllergyIntolerance.reaction`	Details about each adverse reaction event
`AllergyIntolerance.reaction.severity`	Clinical assessment of the severity of the reaction event as a whole

Extensions

More information about the extensions can be found using the links below.

Extension	Context	Link	Comment
allergyIntoleranceEnd	AllergyIntolerance.clinicalStatus	Extension UKCore-AllergyIntoleranceEnd	For the date when the allergy or intolerance `clinicalStatus` is updated to `inactive` or `resolved`.
evidence	AllergyIntolerance	Extension UKCore-Evidence	To reference a `DiagnosticReport` resource for investigations that confirm the certainty of the allergy or intolerance diagnosis.

Bindings (differential)

More information about the bindings to UK Core ValueSets can be found below.

Context	Strength	Link
AllergyIntolerance.code	Preferred	ValueSet UKCore-AllergyCode
AllergyIntolerance.reaction.exposureRoute	Preferred	ValueSet UKCore-SubstanceOrProductAdministrationRoute
AllergyIntolerance.reaction.manifestation	Preferred	ValueSet UKCore-AllergyManifestation
AllergyIntolerance.reaction.substance	Preferred	ValueSet UKCore-AllergySubstance

`verificationStatus`

An optional value from a required terminology binding containing the values;

unconfirmed
confirmed
refuted
entered-in-error.

Note: The use of entered-in-error dictates the population of the AllergyIntolerance.clinicalStatus element, via the ait-1 and ait-2 constraints in the base resource.

`code`

Identifies the causative agent for the allergy or intolerance.

When recording an allergy to a medication substance, the provider system SHOULD use a dm+d concept class or alternatively, when the allergy is not recorded against a medication substance, the relevant set of SNOMED CT. These can be found within the ValueSet UKCore-AllergyCode.

Using transfer degraded drug / non-drug allergy codes

Degraded drug allergy codes can be used in three scenarios, with examples.

1. If only a text representation of the allergy is known.

Table View

AllergyIntolerance.id[0]	UKCore-AllergyIntolerance-Sn-NonDrugAllergy-Example
AllergyIntolerance.clinicalStatus[0].coding[0].system[0]	http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
AllergyIntolerance.clinicalStatus[0].coding[0].code[0]	active
AllergyIntolerance.clinicalStatus[0].coding[0].display[0]	Active
AllergyIntolerance.verificationStatus[0].coding[0].system[0]	http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
AllergyIntolerance.verificationStatus[0].coding[0].code[0]	confirmed
AllergyIntolerance.verificationStatus[0].coding[0].display[0]	Confirmed
AllergyIntolerance.code[0].coding[0].system[0]	http://snomed.info/sct
AllergyIntolerance.code[0].coding[0].code[0]	196471000000108
AllergyIntolerance.code[0].coding[0].display[0]	Transfer-degraded non-drug allergy (record artifact)
AllergyIntolerance.code[0].text[0]	Latex
AllergyIntolerance.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example

Tree View

AllergyIntolerance

id : UKCore-AllergyIntolerance-Sn-NonDrugAllergy-Example

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

code

coding

system : http://snomed.info/sct

code : 196471000000108

display : Transfer-degraded non-drug allergy (record artifact)

text : Latex

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

XML View

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance-Sn-NonDrugAllergy-Example" />
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
            <display value="Confirmed" />
        </coding>
    </verificationStatus>
    <!--  **************Snippet start**************  -->
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="196471000000108" />
            <display value="Transfer-degraded non-drug allergy (record artifact)" />
        </coding>
        <text value="Latex" />
    </code>
    <!--  **************Snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
</AllergyIntolerance>

JSON View

{
    "resourceType": "AllergyIntolerance",
    "id": "UKCore-AllergyIntolerance-Sn-NonDrugAllergy-Example",
    "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"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196471000000108",
                "display": "Transfer-degraded non-drug allergy (record artifact)"
            }
        ],
        "text": "Latex"
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    }
}

2. If a text representation of the allergy is known but any associated coding is not recognised by the system.

Table View

AllergyIntolerance.id[0]	UKCore-AllergyIntolerance-Sn-DrugAllergy-Example
AllergyIntolerance.clinicalStatus[0].coding[0].system[0]	http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
AllergyIntolerance.clinicalStatus[0].coding[0].code[0]	active
AllergyIntolerance.clinicalStatus[0].coding[0].display[0]	Active
AllergyIntolerance.verificationStatus[0].coding[0].system[0]	http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
AllergyIntolerance.verificationStatus[0].coding[0].code[0]	confirmed
AllergyIntolerance.verificationStatus[0].coding[0].display[0]	Confirmed
AllergyIntolerance.code[0].coding[0].system[0]	http://snomed.info/sct
AllergyIntolerance.code[0].coding[0].code[0]	196461000000101
AllergyIntolerance.code[0].coding[0].display[0]	Transfer-degraded drug allergy (record artifact)
AllergyIntolerance.code[0].text[0]	9339101000001105 \| Septrin
AllergyIntolerance.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example

Tree View

AllergyIntolerance

id : UKCore-AllergyIntolerance-Sn-DrugAllergy-Example

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

code

coding

system : http://snomed.info/sct

code : 196461000000101

display : Transfer-degraded drug allergy (record artifact)

text : 9339101000001105 | Septrin

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

XML View

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance-Sn-DrugAllergy-Example" />
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
            <display value="Confirmed" />
        </coding>
    </verificationStatus>
    <!--  **************Snippet start**************  -->
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="196461000000101" />
            <display value="Transfer-degraded drug allergy (record artifact)" />
        </coding>
        <text value="9339101000001105 | Septrin" />
    </code>
    <!--  **************Snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
</AllergyIntolerance>

JSON View

{
    "resourceType": "AllergyIntolerance",
    "id": "UKCore-AllergyIntolerance-Sn-DrugAllergy-Example",
    "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"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196461000000101",
                "display": "Transfer-degraded drug allergy (record artifact)"
            }
        ],
        "text": "9339101000001105 | Septrin"
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    }
}

Note: “Septrin” is a long discontinued brand name of an antibiotic.

3. If a pre-coordinated allergy code is known which this is not part of the permitted value set for causative agent defined above.

Table View

AllergyIntolerance.id[0]	UKCore-AllergyIntolerance-Sn-DrugAllergyToEggProtein-Example
AllergyIntolerance.clinicalStatus[0].coding[0].system[0]	http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
AllergyIntolerance.clinicalStatus[0].coding[0].code[0]	active
AllergyIntolerance.clinicalStatus[0].coding[0].display[0]	Active
AllergyIntolerance.verificationStatus[0].coding[0].system[0]	http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
AllergyIntolerance.verificationStatus[0].coding[0].code[0]	confirmed
AllergyIntolerance.verificationStatus[0].coding[0].display[0]	Confirmed
AllergyIntolerance.code[0].coding[0].system[0]	http://snomed.info/sct
AllergyIntolerance.code[0].coding[0].code[0]	196461000000101
AllergyIntolerance.code[0].coding[0].display[0]	Transfer-degraded drug allergy (record artifact)
AllergyIntolerance.code[0].text[0]	213020009 \| Allergy to egg protein
AllergyIntolerance.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example

Tree View

AllergyIntolerance

id : UKCore-AllergyIntolerance-Sn-DrugAllergyToEggProtein-Example

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

code

coding

system : http://snomed.info/sct

code : 196461000000101

display : Transfer-degraded drug allergy (record artifact)

text : 213020009 | Allergy to egg protein

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

XML View

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance-Sn-DrugAllergyToEggProtein-Example" />
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
            <display value="Confirmed" />
        </coding>
    </verificationStatus>
    <!--  **************Snippet start**************  -->
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="196461000000101" />
            <display value="Transfer-degraded drug allergy (record artifact)" />
        </coding>
        <text value="213020009 | Allergy to egg protein" />
    </code>
    <!--  **************Snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
</AllergyIntolerance>

JSON View

{
    "resourceType": "AllergyIntolerance",
    "id": "UKCore-AllergyIntolerance-Sn-DrugAllergyToEggProtein-Example",
    "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"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196461000000101",
                "display": "Transfer-degraded drug allergy (record artifact)"
            }
        ],
        "text": "213020009 | Allergy to egg protein"
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    }
}

Handling of 'No known allergies'

There can be an explicit assertion of ‘No Known Allergies’ using the SNOMED CT 'No known allergy' hierarchy 716186003 | No known allergy. The parent concept, or any child concept MAY be used.

Example of `AllergyIntolerance.code` usage for 'No known drug allergy':

Table View

AllergyIntolerance.id[0]	UKCore-AllergyIntolerance-Sn-NegHandlNoKnownAllergies-Example
AllergyIntolerance.clinicalStatus[0].coding[0].system[0]	http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
AllergyIntolerance.clinicalStatus[0].coding[0].code[0]	active
AllergyIntolerance.clinicalStatus[0].coding[0].display[0]	Active
AllergyIntolerance.verificationStatus[0].coding[0].system[0]	http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
AllergyIntolerance.verificationStatus[0].coding[0].code[0]	confirmed
AllergyIntolerance.verificationStatus[0].coding[0].display[0]	Confirmed
AllergyIntolerance.code[0].coding[0].system[0]	http://snomed.info/sct
AllergyIntolerance.code[0].coding[0].code[0]	409137002
AllergyIntolerance.code[0].coding[0].display[0]	No known drug allergy (situation)
AllergyIntolerance.patient[0].reference[0]	Patient/UKCore-Patient-RichardSmith-Example

Tree View

AllergyIntolerance

id : UKCore-AllergyIntolerance-Sn-NegHandlNoKnownAllergies-Example

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

code

coding

system : http://snomed.info/sct

code : 409137002

display : No known drug allergy (situation)

patient

reference : Patient/UKCore-Patient-RichardSmith-Example

XML View

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance-Sn-NegHandlNoKnownAllergies-Example" />
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
            <display value="Confirmed" />
        </coding>
    </verificationStatus>
    <!--  **************Snippet start**************  -->
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="409137002" />
            <display value="No known drug allergy (situation)" />
        </coding>
    </code>
    <!--  **************Snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
</AllergyIntolerance>

JSON View

{
    "resourceType": "AllergyIntolerance",
    "id": "UKCore-AllergyIntolerance-Sn-NegHandlNoKnownAllergies-Example",
    "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"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "409137002",
                "display": "No known drug allergy (situation)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    }
}

If other AllergyIntolerance resources exist in the patient record with a AllergyIntolerance.clinicalStatus of active then the system SHALL ignore the 'No Known Allergies' resource instance. The existence of recorded and active allergies takes precedence over instances of 'No Known Allergies' records.

Use of plain text only

The representation of the causative agent as text is supported within the FHIR standard but this SHOULD only be used as a last resort if a suitable coded term does not exist within the SNOMED CT terminology or if using a degraded allergy code is not appropriate.

Use of `nullFlavor`

The UK Core recommendation is that the nullFlavor is not used for the causative agent, even though it is permitted within the FHIR standard.

`patient`

A reference to the patient resource which SHALL conform to Profile UKCore-Patient.

`encounter`

A reference to the encounter resource which SHALL conform to Profile UKCore-Encounter.

`onset[x]`

Record of the date and/or time of the onset of the reaction caused by the allergy or intolerance which can be recorded in one of five ways;

onsetDateTime
onsetAge
onsetPeriod
onsetRange
onsetString.

Provider Systems

Provider systems are recommended to support at least AllergyIntolerance.onsetDateTime and AllergyIntolerance.onsetAge where this date is available.

It is recommended not to record the onset using an AllergyIntolerance.onsetPeriod or AllergyIntolerance.onsetRange as these data types are complex and less useful. If the exact onset date is not known, but was between two known dates, e.g. 2018 and 2019, then use the lower/older date as the AllergyIntolerance.onsetDateTime instead of using an AllergyIntolerance.onsetPeriod.

It is recommended not to record the onset using an AllergyIntolerance.onsetString as this data will not be machine processable.

Provider Systems

Consumer systems SHALL be able to handle any of the AllergyIntolerance.onset data types.

`recordedDate`

The date the first version of the resource instance was recorded.

The recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date.

If the instance of the resource is updated via an operation like a RESTful PATCH or PUT then the AllergyIntolerance.recordedDate is not updated and remains the date the resource instance was recorded.

`recorder`

A reference to the individual who recorded the record and takes responsibility for its content.

The resource being referenced SHALL conform to one of the following:

`asserter`

A reference to the source of the information about the allergy.

The resource being referenced SHALL conform to one of the following:

Provider Systems

Provider systems SHOULD provide at least the following minimum data within the referenced resource.

Practitioner

identifier
name

PractitionerRole

identifier
practitioner (as above) OR organisation.identifier OR healthcareService.identifier

Patient

identifier:nhsNumber
name

RelatedPerson

identifier
name
patient

Where a human asserter is not captured or cannot be confirmed, i.e. the asserter is not a Practitioner, Patient or RelatedPerson, the provider systems SHOULD reference a PractitionerRole.organisation and/or PractitionerRole.healthcareService within a PractitionerRole resource, using the associated ODS code, as per the following example, asserted by "MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST".

Example of `PractitionerRole.organisation` for ODS code usage:

Table View

PractitionerRole.id[0]	UKCore-PractitionerRole-Sn-Organization-Code-Example
PractitionerRole.identifier[0].system[0]	https://fhir.nhs.uk/Id/sds-role-profile-id
PractitionerRole.identifier[0].value[0]	100334993514
PractitionerRole.organization[0].identifier[0].system[0]	https://fhir.nhs.uk/Id/ods-organization-code
PractitionerRole.organization[0].identifier[0].value[0]	RD8
PractitionerRole.organization[0].display[0]	MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

Tree View

PractitionerRole

id : UKCore-PractitionerRole-Sn-Organization-Code-Example

identifier

system : https://fhir.nhs.uk/Id/sds-role-profile-id

value : 100334993514

organization

identifier

system : https://fhir.nhs.uk/Id/ods-organization-code

value : RD8

display : MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

XML View

<PractitionerRole xmlns="http://hl7.org/fhir">
    <id value="UKCore-PractitionerRole-Sn-Organization-Code-Example" />
    <!--  **************snippet start**************  -->
    <identifier>
        <system value="https://fhir.nhs.uk/Id/sds-role-profile-id" />
        <value value="100334993514" />
    </identifier>
    <organization>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/ods-organization-code" />
            <value value="RD8" />
        </identifier>
        <display value="MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST" />
    </organization>
    <!--  **************snippet end**************  -->
</PractitionerRole>

JSON View

{
    "resourceType": "PractitionerRole",
    "id": "UKCore-PractitionerRole-Sn-Organization-Code-Example",
    "identifier":  [
        {
            "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
            "value": "100334993514"
        }
    ],
    "organization": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
            "value": "RD8"
        },
        "display": "MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST"
    }
}

`lastOccurrence`

Represents the date and/or time of the last known occurrence of a reaction event.

`note`

An optional element for when the clinical user wishes to provide supporting textual information for the allergy record that cannot be conveyed within other elements of the resource.

Provider Systems

Where a provider system only has the capability to record a note at one level it SHOULD populate the AllergyIntolerance.note elements with any notes data captured within the system, irrespective of the data level that the system uses to capture that data.

Where a provider system has the capability to record a note at both the AllergyIntolerance and at the AllergyIntolerance.reaction level it SHOULD populate both with the relevant notes applicable to each level.

Provider Systems

Consumer systems SHALL be able to handle both multiple AllergyIntolerance.note and multiple AllergyIntolerance.reaction.note elements.

`reaction`

Details about each adverse reaction event linked to exposure to the identified substance.

The AllergyIntolerance.reaction is optional, but where a AllergyIntolerance.reaction.severity is available in the provider system it SHALL be included to convey severity even if no other reaction details are explicitly available. If this is the case the AllergyIntolerance.reaction.manifestation SHALL be coded as the nullFlavor NI.

`reaction.substance`

An element to record the specific substance or pharmaceutical product considered to be responsible for event using the ValueSet UKCore-AllergySubstance

`reaction.manifestation`

A mandatory element if a AllergyIntolerance.reaction is recorded for the clinical symptoms and/or signs that are observed or associated with the adverse reaction event.

Use nullFlavor NI for the case when a AllergyIntolerance.reaction.severity needs to be shared but where a AllergyIntolerance.reaction.manifestation is not known.

`reaction.severity`

An optional value from a required terminology binding containing the values;

mild
moderate
severe

Provider Systems

Where a severity is available in the provider system it SHALL be included to convey severity even if no other reaction details are explicitly available.

Where the severity is not known, this element SHOULD be omitted.

Provider Systems

Use of this element when populated as severe MAY be used to express life threatening allergies, used in conjunction with the AllergyIntolerance.criticality element.

An omitted AllergyIntolerance.reaction.severity will either mean severity data is not available within the provider system or the severity is not known by the provider system.

`reaction.exposureRoute`

An optional element to identify the route by which the patient was exposed to the substance.

Provider Systems

If this data is available the binding SHOULD be to the ValueSet UKCore-SubstanceOrProductAdministrationRoute.

Provider Systems

Consumer systems are recommended not to include this coded information within automated clinical decision support. This is because it could either mean two quite different things;

The reaction only occurs if the substance enters the body via the specified route, implying the use of other routes is safe.

The reaction was identified when the substance entered the body via the specified route, but could also react when using other routes.

`reaction.note`

An optional element for when the clinical user wishes to provide supporting textual information for the reaction that cannot be conveyed within other elements of the backbone element.

See the related guidance above for AllergyIntolerance.note.

StructureDefinition-UKCore-AllergyIntolerance

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Examples

Usage

Example Usage Scenarios

Profile Specific Implementation Guidance:

Use Case: Query

Use Case: Exchange

Use Case: Migration

Minimum Viable Content

Extensions

Bindings (differential)

verificationStatus

code

Using transfer degraded drug / non-drug allergy codes

1. If only a text representation of the allergy is known.

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2. If a text representation of the allergy is known but any associated coding is not recognised by the system.

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3. If a pre-coordinated allergy code is known which this is not part of the permitted value set for causative agent defined above.

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Handling of 'No known allergies'

Example of AllergyIntolerance.code usage for 'No known drug allergy':

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Use of plain text only

Use of nullFlavor

patient

encounter

onset[x]

Provider Systems

Provider Systems

recordedDate

recorder

asserter

Provider Systems

Example of PractitionerRole.organisation for ODS code usage:

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lastOccurrence

note

Provider Systems

Provider Systems

reaction

reaction.substance

reaction.manifestation

reaction.severity

Provider Systems

Provider Systems

reaction.exposureRoute

Provider Systems

Provider Systems

reaction.note

`verificationStatus`

`code`

Example of `AllergyIntolerance.code` usage for 'No known drug allergy':

Use of `nullFlavor`

`patient`

`encounter`

`onset[x]`

`recordedDate`

`recorder`

`asserter`

Example of `PractitionerRole.organisation` for ODS code usage:

`lastOccurrence`

`note`

`reaction`

`reaction.substance`

`reaction.manifestation`

`reaction.severity`

`reaction.exposureRoute`

`reaction.note`