{ "resourceType": "StructureDefinition", "id": "AllergyIntoleranceMERT", "url": "https://intrahealth.com/fhir/mert/StructureDefinition/AllergyIntoleranceMERT", "name": "AllergyIntoleranceMERT", "title": "AllergyIntolerance (MERT)", "status": "draft", "description": "This profile describes the AllergyIntolerance for MERT.", "fhirVersion": "4.0.1", "kind": "resource", "abstract": false, "type": "AllergyIntolerance", "baseDefinition": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance", "derivation": "constraint", "snapshot": { "element": [ { "id": "AllergyIntolerance", "path": "AllergyIntolerance", "short": "Allergy or Intolerance (generally: Risk of adverse reaction to a substance)", "definition": "Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.", "comment": "Substances include, but are not limited to: a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.", "alias": [ "Allergy", "Intolerance", "Adverse Reaction" ], "min": 0, "max": "*", "base": { "path": "AllergyIntolerance", "min": 0, "max": "*" }, "constraint": [ { "key": "dom-2", "severity": "error", "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources", "expression": "contained.contained.empty()", "xpath": "not(parent::f:contained and f:contained)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-4", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated", "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-3", "severity": "error", "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource", "expression": "contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()", "xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice", "valueBoolean": true }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation", "valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." } ], "key": "dom-6", "severity": "warning", "human": "A resource should have narrative for robust management", "expression": "text.`div`.exists()", "xpath": "exists(f:text/h:div)", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "dom-5", "severity": "error", "human": "If a resource is contained in another resource, it SHALL NOT have a security label", "expression": "contained.meta.security.empty()", "xpath": "not(exists(f:contained/*/f:meta/f:security))", "source": "http://hl7.org/fhir/StructureDefinition/DomainResource" }, { "key": "ait-1", "severity": "error", "human": "AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error.", "expression": "verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()", "xpath": "f:verificationStatus/f:coding/f:code/@value='entered-in-error' or exists(f:clinicalStatus)", "source": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance" }, { "key": "ait-2", "severity": "error", "human": "AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error", "expression": "verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()", "xpath": "not(f:verificationStatus/f:coding/f:code/@value='entered-in-error') or not(exists(f:clinicalStatus))", "source": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "Observation[classCode=OBS, moodCode=EVN]" } ] }, { "id": "AllergyIntolerance.id", "path": "AllergyIntolerance.id", "short": "Logical id of this artifact", "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.", "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.", "min": 0, "max": "1", "base": { "path": "Resource.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "isSummary": true }, { "id": "AllergyIntolerance.meta", "path": "AllergyIntolerance.meta", "short": "Metadata about the resource", "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.", "min": 0, "max": "1", "base": { "path": "Resource.meta", "min": 0, "max": "1" }, "type": [ { "code": "Meta" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "AllergyIntolerance.implicitRules", "path": "AllergyIntolerance.implicitRules", "short": "A set of rules under which this content was created", "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.", "comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.", "min": 0, "max": "1", "base": { "path": "Resource.implicitRules", "min": 0, "max": "1" }, "type": [ { "code": "uri" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "AllergyIntolerance.language", "path": "AllergyIntolerance.language", "short": "Language of the resource content", "definition": "The base language in which the resource is written.", "comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).", "min": 0, "max": "1", "base": { "path": "Resource.language", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet", "valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages" }, { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Language" } ], "strength": "preferred", "description": "A human language.", "valueSet": "http://hl7.org/fhir/ValueSet/languages" }, "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "AllergyIntolerance.text", "path": "AllergyIntolerance.text", "short": "Text summary of the resource, for human interpretation", "definition": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.", "comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.", "alias": [ "narrative", "html", "xhtml", "display" ], "min": 0, "max": "1", "base": { "path": "DomainResource.text", "min": 0, "max": "1" }, "type": [ { "code": "Narrative" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" }, { "identity": "rim", "map": "Act.text?" } ] }, { "id": "AllergyIntolerance.contained", "path": "AllergyIntolerance.contained", "short": "Contained, inline Resources", "definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.", "comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.", "alias": [ "inline resources", "anonymous resources", "contained resources" ], "min": 0, "max": "*", "base": { "path": "DomainResource.contained", "min": 0, "max": "*" }, "type": [ { "code": "Resource" } ], "mapping": [ { "identity": "rim", "map": "Entity. Role, or Act" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "AllergyIntolerance.extension", "path": "AllergyIntolerance.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "AllergyIntolerance.modifierExtension", "path": "AllergyIntolerance.modifierExtension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Extensions that cannot be ignored", "definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "DomainResource.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them", "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "AllergyIntolerance.identifier", "path": "AllergyIntolerance.identifier", "short": "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.", "comment": "This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.", "requirements": "Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers.", "min": 0, "max": "*", "base": { "path": "AllergyIntolerance.identifier", "min": 0, "max": "*" }, "type": [ { "code": "Identifier" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)" }, { "identity": "rim", "map": "II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]" }, { "identity": "servd", "map": "Identifier" }, { "identity": "w5", "map": "FiveWs.identifier" }, { "identity": "v2", "map": "IAM-7" }, { "identity": "rim", "map": "id" } ] }, { "id": "AllergyIntolerance.clinicalStatus", "path": "AllergyIntolerance.clinicalStatus", "short": "active | inactive | resolved", "definition": "The clinical status of the allergy or intolerance.", "comment": "Required in MERT. Uses base required binding (AllergyIntoleranceClinicalStatusCodes).", "min": 1, "max": "1", "base": { "path": "AllergyIntolerance.clinicalStatus", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1", "ait-1", "ait-2" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as no longer active.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AllergyIntoleranceClinicalStatus" } ], "strength": "required", "description": "The clinical status of the allergy or intolerance.", "valueSet": "http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "rim", "map": "Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code=\"clinicalStatus\", moodCode=EVN].value" } ] }, { "id": "AllergyIntolerance.verificationStatus", "path": "AllergyIntolerance.verificationStatus", "short": "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).", "comment": "The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.verificationStatus", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1", "ait-1", "ait-2" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isModifier": true, "isModifierReason": "This element is labeled as a modifier because the status contains the codes refuted and entered-in-error that mark the AllergyIntolerance as not currently valid.", "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AllergyIntoleranceVerificationStatus" } ], "strength": "required", "description": "Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.", "valueSet": "http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.status" }, { "identity": "rim", "map": "Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code=\"verificationStatus\", moodCode=EVN].value" } ] }, { "id": "AllergyIntolerance.type", "path": "AllergyIntolerance.type", "short": "allergy | intolerance - Underlying mechanism (if known)", "definition": "Identification of the underlying physiological mechanism for the reaction risk.", "comment": "Indicates allergy or intolerance mechanism when known. Uses base required binding.", "alias": [ "Category", "Class" ], "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.type", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AllergyIntoleranceType" } ], "strength": "required", "description": "Identification of the underlying physiological mechanism for a Reaction Risk.", "valueSet": "http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.class" }, { "identity": "v2", "map": "IAM-9" }, { "identity": "rim", "map": "code" } ] }, { "id": "AllergyIntolerance.category", "path": "AllergyIntolerance.category", "short": "food | medication | environment | biologic", "definition": "Category of the identified substance.", "comment": "Use category when known (food | medication | environment | biologic). Uses base required binding.", "alias": [ "Category", "Type", "Reaction Type", "Class" ], "min": 0, "max": "*", "base": { "path": "AllergyIntolerance.category", "min": 0, "max": "*" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AllergyIntoleranceCategory" } ], "strength": "required", "description": "Category of an identified substance associated with allergies or intolerances.", "valueSet": "http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.class" }, { "identity": "v2", "map": "AL1-2" }, { "identity": "rim", "map": "value < IntoleranceValue (Agent)" } ] }, { "id": "AllergyIntolerance.criticality", "path": "AllergyIntolerance.criticality", "short": "low | high | unable-to-assess", "definition": "Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance.", "comment": "The default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). Systems that capture a severity at the condition level are actually representing the concept of criticality whereas the severity documented at the reaction level is representing the true reaction severity. Existing systems that are capturing both condition criticality and reaction severity may use the term \"severity\" to represent both. Criticality is the worst it could be in the future (i.e. situation-agnostic) whereas severity is situation-dependent.", "alias": [ "Severity", "Seriousness", "Contra-indication", "Risk" ], "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.criticality", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AllergyIntoleranceCriticality" } ], "strength": "required", "description": "Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.", "valueSet": "http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.grade" }, { "identity": "v2", "map": "AL1-4" }, { "identity": "rim", "map": "inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]" } ] }, { "id": "AllergyIntolerance.code", "path": "AllergyIntolerance.code", "short": "Code that identifies the allergy or intolerance", "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.", "comment": "Transport-first: send existing source coding when available (e.g., DIN for medication allergies). If no appropriate coded concept is available, populate CodeableConcept.text.", "alias": [ "Code" ], "min": 1, "max": "1", "base": { "path": "AllergyIntolerance.code", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "isSummary": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AllergyIntoleranceCode" } ], "strength": "example", "description": "Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.", "valueSet": "http://hl7.org/fhir/ValueSet/allergyintolerance-code" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "w5", "map": "FiveWs.what[x]" }, { "identity": "v2", "map": "AL1-3 / IAM-3" }, { "identity": "rim", "map": "substance/product:\r\r.participation[typeCode=CAGNT].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]\r\rnegated/excluded substance/product:\r\r.participation[typeCode=CAGNT, negationInd=true].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]\r\rpositive or negated/excluded condition/situation:\r\rObservation.code=ASSERTION; Observation.value" } ] }, { "id": "AllergyIntolerance.patient", "path": "AllergyIntolerance.patient", "short": "Who the sensitivity is for", "definition": "The patient who has the allergy or intolerance.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "alias": [ "Patient" ], "min": 1, "max": "1", "base": { "path": "AllergyIntolerance.patient", "min": 1, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://intrahealth.com/fhir/mert/StructureDefinition/PatientMERT" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.subject[x]" }, { "identity": "v2", "map": "(PID-3)" }, { "identity": "rim", "map": ".participation[typeCode=SBJ].role[classCode=PAT]" }, { "identity": "w5", "map": "FiveWs.subject" } ] }, { "id": "AllergyIntolerance.encounter", "path": "AllergyIntolerance.encounter", "short": "Encounter when the allergy or intolerance was asserted", "definition": "The encounter when the allergy or intolerance was asserted.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.encounter", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.context" }, { "identity": "rim", "map": ".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" } ] }, { "id": "AllergyIntolerance.onset[x]", "path": "AllergyIntolerance.onset[x]", "short": "When allergy or intolerance was identified", "definition": "Estimated or actual date, date-time, or age when allergy or intolerance was identified.", "comment": "Use onset[x] when available to indicate when the allergy/intolerance was first identified.", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.onset[x]", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" }, { "code": "Age" }, { "code": "Period" }, { "code": "Range" }, { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.init" }, { "identity": "rim", "map": "effectiveTime.low" } ] }, { "id": "AllergyIntolerance.recordedDate", "path": "AllergyIntolerance.recordedDate", "short": "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.", "comment": "Date the first version of the resource instance was recorded.", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.recordedDate", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "w5", "map": "FiveWs.recorded" }, { "identity": "v2", "map": "IAM-13" }, { "identity": "rim", "map": ".participation[typeCode=AUT].time" } ] }, { "id": "AllergyIntolerance.recorder", "path": "AllergyIntolerance.recorder", "short": "Who recorded the sensitivity", "definition": "Individual who recorded the record and takes responsibility for its content.", "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.", "alias": [ "Author" ], "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.recorder", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "http://hl7.org/fhir/StructureDefinition/Practitioner", "http://hl7.org/fhir/StructureDefinition/PractitionerRole", "http://hl7.org/fhir/StructureDefinition/Patient", "http://hl7.org/fhir/StructureDefinition/RelatedPerson" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.author" }, { "identity": "rim", "map": ".participation[typeCode=AUT].role" } ] }, { "id": "AllergyIntolerance.asserter", "path": "AllergyIntolerance.asserter", "short": "Source of the information about the allergy", "definition": "The source of the information about the allergy that is recorded.", "comment": "The recorder takes responsibility for the content, but can reference the source from where they got it.", "alias": [ "Source", "Informant" ], "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.asserter", "min": 0, "max": "1" }, "type": [ { "code": "Reference", "targetProfile": [ "https://intrahealth.com/fhir/mert/StructureDefinition/PractitionerMERT" ] } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ref-1", "severity": "error", "human": "SHALL have a contained resource if a local reference is provided", "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))", "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])", "source": "http://hl7.org/fhir/StructureDefinition/Reference" } ], "mustSupport": true, "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)" }, { "identity": "w5", "map": "FiveWs.source" }, { "identity": "v2", "map": "IAM-14 (if patient) / IAM-18 (if practitioner)" }, { "identity": "rim", "map": ".participation[typeCode=INF].role" } ] }, { "id": "AllergyIntolerance.lastOccurrence", "path": "AllergyIntolerance.lastOccurrence", "short": "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.", "comment": "This date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used.", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.lastOccurrence", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)].effectiveTime" } ] }, { "id": "AllergyIntolerance.note", "path": "AllergyIntolerance.note", "short": "Additional text not captured in other fields", "definition": "Additional narrative about the propensity for the Adverse Reaction, not captured in other fields.", "comment": "Additional information about the allergy/intolerance not captured in structured fields.", "min": 0, "max": "*", "base": { "path": "AllergyIntolerance.note", "min": 0, "max": "*" }, "type": [ { "code": "Annotation" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Act" }, { "identity": "rim", "map": "subjectOf.observationEvent[code=\"annotation\"].value" } ] }, { "id": "AllergyIntolerance.reaction", "path": "AllergyIntolerance.reaction", "short": "Adverse Reaction Events linked to exposure to substance", "definition": "Details about each adverse reaction event linked to exposure to the identified substance.", "comment": "Details about adverse reaction events linked to exposure.", "min": 0, "max": "*", "base": { "path": "AllergyIntolerance.reaction", "min": 0, "max": "*" }, "type": [ { "code": "BackboneElement" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)]" } ] }, { "id": "AllergyIntolerance.reaction.id", "path": "AllergyIntolerance.reaction.id", "representation": [ "xmlAttr" ], "short": "Unique id for inter-element referencing", "definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.", "min": 0, "max": "1", "base": { "path": "Element.id", "min": 0, "max": "1" }, "type": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type", "valueUrl": "string" } ], "code": "http://hl7.org/fhirpath/System.String" } ], "mapping": [ { "identity": "rim", "map": "n/a" } ] }, { "id": "AllergyIntolerance.reaction.extension", "path": "AllergyIntolerance.reaction.extension", "slicing": { "discriminator": [ { "type": "value", "path": "url" } ], "description": "Extensions are always sliced by (at least) url", "rules": "open" }, "short": "Additional content defined by implementations", "definition": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "alias": [ "extensions", "user content" ], "min": 0, "max": "*", "base": { "path": "Element.extension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "AllergyIntolerance.reaction.modifierExtension", "path": "AllergyIntolerance.reaction.modifierExtension", "short": "Extensions that cannot be ignored even if unrecognized", "definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).", "comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.", "requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).", "alias": [ "extensions", "user content", "modifiers" ], "min": 0, "max": "*", "base": { "path": "BackboneElement.modifierExtension", "min": 0, "max": "*" }, "type": [ { "code": "Extension" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" }, { "key": "ext-1", "severity": "error", "human": "Must have either extensions or value[x], not both", "expression": "extension.exists() != value.exists()", "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])", "source": "http://hl7.org/fhir/StructureDefinition/Extension" } ], "isModifier": true, "isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them", "isSummary": true, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "N/A" } ] }, { "id": "AllergyIntolerance.reaction.substance", "path": "AllergyIntolerance.reaction.substance", "short": "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.", "comment": "Specific substance or product responsible for the reaction (base example binding).", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.reaction.substance", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "SubstanceCode" } ], "strength": "example", "description": "Codes defining the type of the substance (including pharmaceutical products).", "valueSet": "http://hl7.org/fhir/ValueSet/substance-code" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].participation[typeCode=CSM].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]" } ] }, { "id": "AllergyIntolerance.reaction.manifestation", "path": "AllergyIntolerance.reaction.manifestation", "short": "Clinical symptoms/signs associated with the Event", "definition": "Clinical symptoms and/or signs that are observed or associated with the adverse reaction event.", "comment": "Clinical signs or symptoms associated with the reaction. Prefer SNOMED CT when available.", "alias": [ "Symptoms", "Signs" ], "min": 1, "max": "*", "base": { "path": "AllergyIntolerance.reaction.manifestation", "min": 1, "max": "*" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "Manifestation" } ], "strength": "example", "description": "Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.", "valueSet": "http://hl7.org/fhir/ValueSet/clinical-findings" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "v2", "map": "AL1-5" }, { "identity": "rim", "map": "code" } ] }, { "id": "AllergyIntolerance.reaction.description", "path": "AllergyIntolerance.reaction.description", "short": "Description of the event as a whole", "definition": "Text description about the reaction as a whole, including details of the manifestation if required.", "comment": "Narrative description of the reaction event.", "alias": [ "Narrative", "Text" ], "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.reaction.description", "min": 0, "max": "1" }, "type": [ { "code": "string" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "text" } ] }, { "id": "AllergyIntolerance.reaction.onset", "path": "AllergyIntolerance.reaction.onset", "short": "Date(/time) when manifestations showed", "definition": "Record of the date and/or time of the onset of the Reaction.", "comment": "Date/time when reaction manifestations occurred.", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.reaction.onset", "min": 0, "max": "1" }, "type": [ { "code": "dateTime" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "AL1-6" }, { "identity": "rim", "map": "effectiveTime.low" } ] }, { "id": "AllergyIntolerance.reaction.severity", "path": "AllergyIntolerance.reaction.severity", "short": "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.", "comment": "Severity of the reaction event (mild | moderate | severe). Uses base required binding.", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.reaction.severity", "min": 0, "max": "1" }, "type": [ { "code": "code" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mustSupport": true, "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "AllergyIntoleranceSeverity" } ], "strength": "required", "description": "Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.", "valueSet": "http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "rim", "map": "inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]" } ] }, { "id": "AllergyIntolerance.reaction.exposureRoute", "path": "AllergyIntolerance.reaction.exposureRoute", "short": "How the subject was exposed to the substance", "definition": "Identification of the route by which the subject was exposed to the substance.", "comment": "Route of exposure (e.g., oral, inhaled). Prefer SNOMED CT route codes when available.", "min": 0, "max": "1", "base": { "path": "AllergyIntolerance.reaction.exposureRoute", "min": 0, "max": "1" }, "type": [ { "code": "CodeableConcept" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "binding": { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName", "valueString": "RouteOfAdministration" } ], "strength": "example", "description": "A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.", "valueSet": "http://hl7.org/fhir/ValueSet/route-codes" }, "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "CE/CNE/CWE" }, { "identity": "rim", "map": "CD" }, { "identity": "orim", "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD" }, { "identity": "rim", "map": "outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].routeCode" } ] }, { "id": "AllergyIntolerance.reaction.note", "path": "AllergyIntolerance.reaction.note", "short": "Text about event not captured in other fields", "definition": "Additional text about the adverse reaction event not captured in other fields.", "comment": "Additional text about the reaction not captured elsewhere.", "min": 0, "max": "*", "base": { "path": "AllergyIntolerance.reaction.note", "min": 0, "max": "*" }, "type": [ { "code": "Annotation" } ], "condition": [ "ele-1" ], "constraint": [ { "key": "ele-1", "severity": "error", "human": "All FHIR elements must have a @value or children", "expression": "hasValue() or (children().count() > id.count())", "xpath": "@value|f:*|h:div", "source": "http://hl7.org/fhir/StructureDefinition/Element" } ], "mapping": [ { "identity": "rim", "map": "n/a" }, { "identity": "v2", "map": "N/A" }, { "identity": "rim", "map": "Act" }, { "identity": "rim", "map": "subjectOf.observationEvent[code=\"annotation\"].value" } ] } ] }, "differential": { "element": [ { "id": "AllergyIntolerance.clinicalStatus", "path": "AllergyIntolerance.clinicalStatus", "comment": "Required in MERT. Uses base required binding (AllergyIntoleranceClinicalStatusCodes).", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.type", "path": "AllergyIntolerance.type", "comment": "Indicates allergy or intolerance mechanism when known. Uses base required binding.", "mustSupport": true }, { "id": "AllergyIntolerance.category", "path": "AllergyIntolerance.category", "comment": "Use category when known (food | medication | environment | biologic). Uses base required binding." }, { "id": "AllergyIntolerance.code", "path": "AllergyIntolerance.code", "comment": "Transport-first: send existing source coding when available (e.g., DIN for medication allergies). If no appropriate coded concept is available, populate CodeableConcept.text.", "min": 1, "mustSupport": true }, { "id": "AllergyIntolerance.patient", "path": "AllergyIntolerance.patient", "type": [ { "code": "Reference", "targetProfile": [ "https://intrahealth.com/fhir/mert/StructureDefinition/PatientMERT" ] } ], "mustSupport": true }, { "id": "AllergyIntolerance.encounter", "path": "AllergyIntolerance.encounter", "mustSupport": true }, { "id": "AllergyIntolerance.onset[x]", "path": "AllergyIntolerance.onset[x]", "comment": "Use onset[x] when available to indicate when the allergy/intolerance was first identified.", "mustSupport": true }, { "id": "AllergyIntolerance.recordedDate", "path": "AllergyIntolerance.recordedDate", "comment": "Date the first version of the resource instance was recorded.", "mustSupport": true }, { "id": "AllergyIntolerance.asserter", "path": "AllergyIntolerance.asserter", "type": [ { "code": "Reference", "targetProfile": [ "https://intrahealth.com/fhir/mert/StructureDefinition/PractitionerMERT" ] } ], "mustSupport": true }, { "id": "AllergyIntolerance.note", "path": "AllergyIntolerance.note", "comment": "Additional information about the allergy/intolerance not captured in structured fields.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction", "path": "AllergyIntolerance.reaction", "comment": "Details about adverse reaction events linked to exposure.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.substance", "path": "AllergyIntolerance.reaction.substance", "comment": "Specific substance or product responsible for the reaction (base example binding)." }, { "id": "AllergyIntolerance.reaction.manifestation", "path": "AllergyIntolerance.reaction.manifestation", "comment": "Clinical signs or symptoms associated with the reaction. Prefer SNOMED CT when available.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.description", "path": "AllergyIntolerance.reaction.description", "comment": "Narrative description of the reaction event." }, { "id": "AllergyIntolerance.reaction.onset", "path": "AllergyIntolerance.reaction.onset", "comment": "Date/time when reaction manifestations occurred." }, { "id": "AllergyIntolerance.reaction.severity", "path": "AllergyIntolerance.reaction.severity", "comment": "Severity of the reaction event (mild | moderate | severe). Uses base required binding.", "mustSupport": true }, { "id": "AllergyIntolerance.reaction.exposureRoute", "path": "AllergyIntolerance.reaction.exposureRoute", "comment": "Route of exposure (e.g., oral, inhaled). Prefer SNOMED CT route codes when available." }, { "id": "AllergyIntolerance.reaction.note", "path": "AllergyIntolerance.reaction.note", "comment": "Additional text about the reaction not captured elsewhere." } ] } }