UK Core Implementation Guide 0.3.0 STU1

StructureDefinition-UKCore-AllergyIntolerance

Defines the UK Core constraints and extensions on the AllergyIntolerance resource for the minimal set of data to query and retrieve allergy information.

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 MUST 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.

Snapshot View

allergyIntoleranceEndI0..1Extension(Complex)
evidenceI0..*Extension(Reference(UK Core DiagnosticReport))
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
clinicalStatusΣ ?! I0..1CodeableConceptBinding
verificationStatusΣ ?! I0..1CodeableConceptBinding
typeΣ0..1codeBinding
categoryΣ0..*codeBinding
criticalityΣ0..1codeBinding
codeΣ1..1CodeableConceptBinding
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
onsetDateTimedateTime
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
recordedDate0..1dateTime
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
lastOccurrence0..1dateTime
authorStringstring
authorReferenceReference(UK Core Practitioner | UK Core Patient | UK Core RelatedPerson | UK Core Organization)
timeΣ0..1dateTime
textΣ1..1markdown
substance0..1CodeableConceptBinding
manifestation1..*CodeableConceptBinding
description0..1string
onset0..1dateTime
severity0..1codeBinding
exposureRoute0..1CodeableConceptBinding
authorStringstring
authorReferenceReference(UK Core Practitioner | UK Core Patient | UK Core RelatedPerson | UK Core Organization)
timeΣ0..1dateTime
textΣ1..1markdown

Differential View

allergyIntoleranceEndI0..1Extension(Complex)
evidenceI0..*Extension(Reference(UK Core DiagnosticReport))
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
clinicalStatusΣ ?! I0..1CodeableConceptBinding
verificationStatusΣ ?! I0..1CodeableConceptBinding
typeΣ0..1codeBinding
categoryΣ0..*codeBinding
criticalityΣ0..1codeBinding
codeΣ1..1CodeableConceptBinding
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
onsetDateTimedateTime
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
recordedDate0..1dateTime
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
lastOccurrence0..1dateTime
authorStringstring
authorReferenceReference(UK Core Practitioner | UK Core Patient | UK Core RelatedPerson | UK Core Organization)
timeΣ0..1dateTime
textΣ1..1markdown
substance0..1CodeableConceptBinding
manifestation1..*CodeableConceptBinding
description0..1string
onset0..1dateTime
severity0..1codeBinding
exposureRoute0..1CodeableConceptBinding
authorStringstring
authorReferenceReference(UK Core Practitioner | UK Core Patient | UK Core RelatedPerson | UK Core Organization)
timeΣ0..1dateTime
textΣ1..1markdown

Hybrid View

allergyIntoleranceEndI0..1Extension(Complex)
evidenceI0..*Extension(Reference(UK Core DiagnosticReport))
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
clinicalStatusΣ ?! I0..1CodeableConceptBinding
verificationStatusΣ ?! I0..1CodeableConceptBinding
typeΣ0..1codeBinding
categoryΣ0..*codeBinding
criticalityΣ0..1codeBinding
codeΣ1..1CodeableConceptBinding
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
onsetDateTimedateTime
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
recordedDate0..1dateTime
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
referenceΣ I0..1string
typeΣ0..1uriBinding
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ0..1uri
valueΣ0..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(UK Core Organization)
displayΣ0..1string
lastOccurrence0..1dateTime
authorStringstring
authorReferenceReference(UK Core Practitioner | UK Core Patient | UK Core RelatedPerson | UK Core Organization)
timeΣ0..1dateTime
textΣ1..1markdown
substance0..1CodeableConceptBinding
manifestation1..*CodeableConceptBinding
description0..1string
onset0..1dateTime
severity0..1codeBinding
exposureRoute0..1CodeableConceptBinding
authorStringstring
authorReferenceReference(UK Core Practitioner | UK Core Patient | UK Core RelatedPerson | UK Core Organization)
timeΣ0..1dateTime
textΣ1..1markdown

Table View

AllergyIntolerance..
AllergyIntolerance.extension0..
AllergyIntolerance.extensionExtension0..
AllergyIntolerance.extensionExtension0..
AllergyIntolerance.identifier..
AllergyIntolerance.identifier.assignerReference(UK Core Organization)..
AllergyIntolerance.code1..
AllergyIntolerance.patientReference(UK Core Patient)..
AllergyIntolerance.patient.identifier..
AllergyIntolerance.patient.identifier.assignerReference(UK Core Organization)..
AllergyIntolerance.encounterReference(UK Core Encounter)..
AllergyIntolerance.encounter.identifier..
AllergyIntolerance.encounter.identifier.assignerReference(UK Core Organization)..
AllergyIntolerance.recorderReference(UK Core Practitioner | UK Core PractitionerRole | UK Core Patient | UK Core RelatedPerson)..
AllergyIntolerance.recorder.identifier..
AllergyIntolerance.recorder.identifier.assignerReference(UK Core Organization)..
AllergyIntolerance.asserterReference(UK Core Patient | UK Core RelatedPerson | UK Core Practitioner | UK Core PractitionerRole)..
AllergyIntolerance.asserter.identifier..
AllergyIntolerance.asserter.identifier.assignerReference(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="2.2.0" />
    <name value="UKCoreAllergyIntolerance" />
    <title value="UK Core AllergyIntolerance" />
    <status value="active" />
    <date value="2022-03-01" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="secretariat@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <contact>
        <name value="NHS Digital" />
        <telecom>
            <system value="email" />
            <value value="interoperabilityteam@nhs.net" />
            <use value="work" />
            <rank value="2" />
        </telecom>
    </contact>
    <description value="Defines the UK Core constraints and extensions on the AllergyIntolerance resource for the minimal set of data to query and retrieve allergy information." />
    <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. \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. \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." />
    <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:allergyIntoleranceEnd">
            <path value="AllergyIntolerance.extension" />
            <sliceName value="allergyIntoleranceEnd" />
            <min value="0" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd" />
            </type>
        </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.code">
            <path value="AllergyIntolerance.code" />
            <min value="1" />
            <binding>
                <strength value="extensible" />
                <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="extensible" />
                <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="extensible" />
                <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="extensible" />
                <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": "2.2.0",
    "name": "UKCoreAllergyIntolerance",
    "title": "UK Core AllergyIntolerance",
    "status": "active",
    "date": "2022-03-01",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "secretariat@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        },
        {
            "name": "NHS Digital",
            "telecom":  [
                {
                    "system": "email",
                    "value": "interoperabilityteam@nhs.net",
                    "use": "work",
                    "rank": 2
                }
            ]
        }
    ],
    "description": "Defines the UK Core constraints and extensions on the AllergyIntolerance resource for the minimal set of data to query and retrieve allergy information.",
    "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. \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. \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.",
    "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:allergyIntoleranceEnd",
                "path": "AllergyIntolerance.extension",
                "sliceName": "allergyIntoleranceEnd",
                "min": 0,
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd"
                        ]
                    }
                ]
            },
            {
                "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.code",
                "path": "AllergyIntolerance.code",
                "min": 1,
                "binding": {
                    "strength": "extensible",
                    "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": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AllergySubstance"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.manifestation",
                "path": "AllergyIntolerance.reaction.manifestation",
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.exposureRoute",
                "path": "AllergyIntolerance.reaction.exposureRoute",
                "binding": {
                    "strength": "extensible",
                    "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
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 List - An example to illustrate a list of allergies contained in a Bundle resource.
Example UKCore-Bundle-BundledAllergyList

Minimum Viable Dataset

A minimum viable dataset that all provider and consumer systems should support is the following elements.

Element Reason
identifer To allow the resource to be referenced within/by other resources
clinicalStatus To allow consumers to distinguish between active, inactive and resolved records
code To identify the causative agent from the SNOMED-CT or dm+d coding systems
patient To identify the patient
recordedDate To ensure there is at least one date available to consumer systems to present records chronologically
asserter To identify the source of the information

extension: allergyIntoleranceEnd

More information about this extension can be found using the link below.

Extension UKCore-AllergyIntoleranceEnd


extension: evidence

Extension UKCore-Evidence to reference a DiagnosticReport resource for investigations that confirm the certainty of the allergy or intolerance diagnosis.


identifier

The identifier is the most important element of a FHIR resource for interoperability. It acts as the externally facing unique business identifier for the resource. A key phrase from the FHIR R4 standard is;

[for identifier] ...All resources that have an identifier element support searching by the identifier, so that records can be located by that method.

Provider Systems

It is recommended that the identifier value is a Universally Unique Identifier (UUID) as there is no nationally recognised business indentier for an instance of a recorded condition

Consumer Systems

Consumer systems MUST consume this data.


clinicalStatus

A value from a required terminology binding containing the values;

  • active
  • inactive
  • resolved.

The FHIR standard states this element SHALL be present if verificationStatus is not entered-in-error, but SHALL NOT be present if verificationStatus is entered-in-error.

Provider Systems

Provider systems MUST provide this data.

Consumer Systems

Consumer systems MUST consume this data.

Handling changes in clinical status

A recorded allergy may be subsequently proven to have a different clinical status, e.g. from active to inactive. In this scenario provider systems should create a new instance of this resource to reflect the change of clinical status.

This is opposed to updating the existing instance of the resource. This resource has no data element that could convey a last updated date. Also the action of updating the resource may not be picked up by consumer systems. Creating a new instance of the resource is the safer implementation approach.


verificationStatus

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

  • unconfirmed
  • confirmed
  • refuted
  • entered-in-error.

Note that the use of entered-in-error dictates the population of the clinicalStatus element.

Provider Systems

This element is optional.

Consumer Systems

If omitted, a verification status akin to confirmed should be assumed.


type

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

  • allergy
  • intolerance.

Provider Systems

It is recommended to omit this element. There are no confirmed use cases where clinical system functionality or logic would change based on this data. There are no confirmed use cases where the clinical practitioner would change a care plan based on this data.

Consumer Systems

This element can be ignored.


category

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

  • food
  • medication
  • environment
  • biologic.

Provider Systems

It is recommended to omit this element. There are no confirmed use cases where clinical system functionality or logic would change based on this data. There are no confirmed use cases where the clinical practitioner would change a care plan based on this data.

Consumer Systems

This element can be ignored.


criticality

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

  • low
  • high
  • unable-to-assess,

Use of this element when populated as high may be used to express life threatening allergies, used in conjunction with the AllergyIntolerance.reaction.severity element.

Provider Systems

This element is optional.

Consumer Systems

If omitted, a criticality akin to low should be assumed.


code (Mandatory)

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.

  • National Health Service dictionary of medicines and devices combination drug Virtual Therapeutic Moiety (VTM) – just the drugs, no formulation. May be additional concepts to those in SNOMED-CT (SCT) hierarchy.
  • National Health Service dictionary of medicines and devices Virtual Medicinal Product (VMP) - generic drug products and also generic appliance/ device concepts. May be additional concepts to those in SCT hierarchy and will support the recording of allergies to bandages and dressings etc. Device/appliances are concepts that would not be within scope of SCT pharmaceutical/biologic product hierarchy.
  • National Health Service dictionary of medicines and devices Actual Medicinal Product (AMP) – branded drug products and branded appliance/device concepts that would not be within scope of SCT pharmaceutical/ biologic product hierarchy.
  • National Health Service dictionary of medicines and devices ingredient – just the drug ingredients, no formulation. May be additional concepts to those in SCT hierarchy. Important to have this in addition to VTM as some things may be more specific at VTM level for example things only available as combinations where VTM would only be the combination also VTM may not identify the salt but this concept class would support that.

Alternatively, or when the allergy is not recorded against a medication substance, the relevant set of SNOMED CT codes is a union of the following.

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.

XML


<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>

JSON


"code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196471000000108",
                "display": "transfer-degraded non-drug allergy(record artifact)"
            }
        ],
        "text": "Latex"
    }

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

XML

<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>


JSON

"code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196461000000101",
                "display": "transfer-degraded drug allergy (record artifact)"
            }
        ],
        "text": "9339101000001105 | Septrin"
    }

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

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

XML

<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>

JSON

"code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196461000000101",
                "display": "transfer-degraded drug allergy (record artifact)"
            }
        ],
        "text": "213020009 | Allergy to egg protein"
    }

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.

Provider Systems

Provider systems MUST provide this data.

Consumer Systems

Consumer systems MUST consume this data.


patient (Mandatory)

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

Provider Systems

Provider systems MUST provide this data.

Within a FHIR Messaging or FHIR Document implementation, include a UKCore-Patient resource within the Bundle with at least the minimum dataset populated as defined within the UK Core standard. The reference points to the resource in the Bundle.

XML

<!-- within the AllergyIntolernce resource...-->
<patient>
  <reference value="urn:patient-011223344"/>
  <display value="Richard Smith"/>
</patient>
<!-- elsewhere in the Bundle...-->
  <Patient>
    <id value="urn:patient-011223344"/>
    <identifier>
      <system value="https://fhir.nhs.uk/Id/nhs-number"/>
      <value value="9912003888"/>
    </identifier>
    <name>
      <use value="official"/>
      <text value="Mr Richard Smith"/>
      <family value="Smith/>
      <given value="Richard/>
      <prefix value="Mr"/>
    </name>
    <gender value="male"/>
    <birthDate value="1956-02-04"/>>
  </Patient>


JSON

// within the AllergyIntolernce resource...

  "patient": {
    "reference": "urn:patient-011223344",
    "display": "Richard Smith",
  }

// elsewhere in the Bundle...


  {
    "fullUrl": "urn:patient-011223344",
    "resource": {
      "resourceType": "Patient",
      "id": "urn:patient-011223344",
      "identifier": {
        "system": "https://fhir.nhs.uk/Id/nhs-number",
        "value": "9912003888"
      },
      "name": {
        "use": "official",
        "text": "Mr Richard Smith",
        "family": "Smith",
        "given": "Richard",
        "prefix": "Mr"
      },
      "gender": "male",
      "birthDate": "1956-02-04"
    }
  }

Within a RESTful implemementation a reference and/or identifier MUST be provided that allows the consumer system to query another API if they need to access the complete UKCore-Patient resource. The reference points to the resource in the Bundle.

For implementations within England and Wales, the identifier could be the patient's NHS Number, allowing consumer system to use the NHS Digital Personal Demographics Service FHIR API return a Patient resource.

XML

<patient>
  <reference value="urn:patient-011223344"/>
  <display value="Richard Smith"/>
  <identifier>
    <system value="https://fhir.nhs.uk/Id/nhs-number"/>
    <value value="9912003888"/>
  </identifier>
</patient>

JSON

{
  "patient": {
    "reference": "urn:patient-011223344",
    "display": "Richard Smith",
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/nhs-number",
      "value": "9912003888"
    }
  }
}

For implementations within Scotland, the identifier could be the patient's CHI Number.

XML

<patient>
  <reference value="urn:patient-011223344"/>
  <display value="Richard Smith"/>
  <identifier>
    <system value="https://fhir.nhs.uk/Id/chi-number"/>
    <value value="0402568876"/>
  </identifier>
</patient>

JSON

{
  "patient": {
    "reference": "urn:patient-011223344",
    "display": "Richard Smith",
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/chi-number",
      "value": "0402568876"
    }
  }
}

Consumer Systems

Consumer systems MUST consume this data.


encounter

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

Implementation guidance is pending further analysis for the potential use of this element.


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 onsetDateTime and onsetAge where this date is available.

It is recommended not to record the onset using an onsetPeriod or 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 onsetDateTime instead of using an onsetPeriod.

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

Consumer Systems

Consumer systems MUST be able to handle any of the 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 recordedDate is not updated and remains the date the resource instance was recorded.

Provider Systems

Provider systems MUST provide this data.

Consumer Systems

Consumer systems MUST consume this data.


recorder

A reference to the individual who recorded the record and takes responsibility for its content. The resource being referenced should conform to one of the following:

Provider Systems

Provider systems should provide this data.

Consumer Systems

Consumer systems should consume this data.


asserter

A reference to the source of the information about the allergy. The resource being referenced should conform to one of the following:

Provider Systems

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

practioner

  • identifier
  • name

practionerRole

  • 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. a practioner, patient or relatedPerson, the provider systems should reference an Organisation and/or healthcareService within a PractitonerRole, using the associated ODS code.

For example, asserted by "MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST".

XML

<PractitionerRole>
  <identifier>
   <value value="7d107ed2-70c6-43d9-9cbe-f19c319d1456"/>
  <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>
</PractitionerRole>

JSON

{
  "resource": {
    "resourceType": "PractitionerRole",
    "identifier": [
      {
        "value": "7d107ed2-70c6-43d9-9cbe-f19c319d1456"
      }
    ],
    "organization": {
      "identifier": {
        "system": "https://fhir.nhs.uk/Id/ods-organization-code",
        "value": "RD8"
      },
      "display": "MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST"
    }
  }
}

Consumer Systems

Consumer systems MUST consume this data.


lastOccurence

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

Provider Systems

Provider systems should populate with the date or date/time of the last known occurrence of a reaction to the allergy, if known.

Consumer Systems

Consumer systems may choose to consume this data.


note

An optional element for when the clinical user wishes to provides 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.

Consumer Systems

Consumer systems MUST 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 severity is available in the provider system it MUST be included to convey severity even if no other reaction details are explicitly available. If this is the case the AllergyIntolerance.reaction.manifestation MUST be coded as the nullFlavor NI.

Element: reaction.substance

An optional element to record the specific substance or pharmaceutical product considered to be responsible for event.

Provider Systems

When recording a reaction to a medication substance, the provider system should use a dm+d concept class.

  • National Health Service dictionary of medicines and devices combination drug Virtual Therapeutic Moiety (VTM) – just the drugs, no formulation. May be additional concepts to those in the SNOMED-CT hierarchy.
  • National Health Service dictionary of medicines and devices Virtual Medicinal Product (VMP) - generic drug products and also generic appliance/ device concepts. May be additional concepts to those in the SNOMED-CT hierarchy and will support the recording of allergies to bandages and dressings etc. Device/appliances are concepts that would not be within scope of the SNOMED-CT pharmaceutical/biologic product hierarchy.
  • National Health Service dictionary of medicines and devices Actual Medicinal Product (AMP) – branded drug products and branded appliance/device concepts that would not be within scope of the SNOMED-CT pharmaceutical/ biologic product hierarchy.
  • National Health Service dictionary of medicines and devices ingredient – just the drug ingredients, no formulation. May be additional concepts to those in the SNOMED-CT hierarchy. Important to have this in addition to VTM as some things may be more specific at VTM level for example things only available as combinations where VTM would only be the combination also VTM may not identify the salt but this concept class would support that.

Alternatively, the reaction substance can be recorded using a SNOMED CT code from a union of the following.

Consumer Systems

Consumer systems may consume this data.

Element: reaction.manifestation (Mandatory)

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

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

Element: reaction.description

An optional text description about the reaction as a whole, including more verbose details of the manifestation if required.

Element: reaction.onset

An optional date or date/time when the manifestation showed.

This FHIR element may be populated if known.

Element: 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 MUST 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.

Consumer 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 severity will either mean severity date is not available within the provider system or the severity is not known by the provider system.

Element: 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 999000051000001100 | ePrescribing route of administration simple reference set.

Consumer 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;

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

OR

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

Element: reaction.note

An optional element for when the clinical user wishes to provides 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.


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