{
  "resourceType": "StructureDefinition",
  "id": "profile-allergyintolerance",
  "meta": {
    "lastUpdated": "2021-10-27T01:52:46.665+00:00"
  },
  "url": "https://simplifier.net/omd-cdss/allergyintoleranceprofile",
  "version": "0.0.3",
  "name": "AllergyIntoleranceProfile",
  "title": "Allergy Intolerance Profile",
  "status": "draft",
  "date": "2021-10-24T23:10:10.7705133+00:00",
  "publisher": "OMD",
  "description": "Proposed constraints and extensions on the AllergyIntolerance Resource",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "CA",
          "display": "Canada"
        }
      ]
    }
  ],
  "fhirVersion": "4.0.1",
  "mapping": [
    {
      "identity": "CDSS5.1",
      "uri": "www.ontariomd.com",
      "name": "CDS-S 5.1"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "AllergyIntolerance",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "AllergyIntolerance",
        "path": "AllergyIntolerance",
        "short": "AllergyIntolerance Profile",
        "definition": "The AllergyIntolerance Profile is based upon the core FHIR AllergyIntolerance Resource"
      },
      {
        "id": "AllergyIntolerance.identifier",
        "path": "AllergyIntolerance.identifier",
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.clinicalStatus",
        "path": "AllergyIntolerance.clinicalStatus",
        "mustSupport": 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."
      },
      {
        "id": "AllergyIntolerance.verificationStatus",
        "path": "AllergyIntolerance.verificationStatus",
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.verificationStatus.coding",
        "path": "AllergyIntolerance.verificationStatus.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "system"
            }
          ],
          "rules": "closed"
        },
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.verificationStatus.coding:StatusCode",
        "path": "AllergyIntolerance.verificationStatus.coding",
        "sliceName": "StatusCode",
        "short": "Code for allergy or intolerance status",
        "definition": "Code for an allergy or intolerance statement. Represents whether an allergy/intolerance is active or resolved (indicating no longer active).",
        "comment": "The binding strength of this element is [Preferred](https://www.hl7.org/fhir/terminologies.html#strength), meaning that codes are encouraged to draw from the AllergyIntoleranceStatusCode value set for interoperability purposes but are not required to do so to be considered conformant.",
        "max": "1",
        "binding": {
          "strength": "preferred",
          "description": "Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.",
          "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode"
        }
      },
      {
        "id": "AllergyIntolerance.verificationStatus.coding:StatusCode.system",
        "path": "AllergyIntolerance.verificationStatus.coding.system",
        "min": 1
      },
      {
        "id": "AllergyIntolerance.verificationStatus.coding:StatusCode.code",
        "path": "AllergyIntolerance.verificationStatus.coding.code",
        "min": 1
      },
      {
        "id": "AllergyIntolerance.verificationStatus.coding:@default",
        "path": "AllergyIntolerance.verificationStatus.coding",
        "sliceName": "@default",
        "definition": "Code for an allergy or intolerance statement. This may be a code for a substance or pharmaceutical product that is considered to be responsible for the adverse reaction risk, an allergy or intolerance condition.",
        "comment": "The binding strength of this element is [Required](https://hl7.org/fhir/R4/terminologies.html#required), meaning that codes SHALL be taken from the specified value set to be conformant",
        "min": 1,
        "max": "1",
        "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"
        }
      },
      {
        "id": "AllergyIntolerance.verificationStatus.coding:@default.system",
        "path": "AllergyIntolerance.verificationStatus.coding.system",
        "min": 1,
        "fixedUri": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"
      },
      {
        "id": "AllergyIntolerance.verificationStatus.coding:@default.code",
        "path": "AllergyIntolerance.verificationStatus.coding.code",
        "min": 1
      },
      {
        "id": "AllergyIntolerance.type",
        "path": "AllergyIntolerance.type",
        "definition": "BASE RESOURCE DEFINITION:\r\nIdentification of the underlying physiological mechanism for the reaction risk.\r\n\r\nCDS-S PROFILE DEFINITION:\r\nIdentifies whether the reaction is an allergy or an adverse reaction (including intolerance and side effects).",
        "mapping": [
          {
            "identity": "CDSS5.1",
            "map": "DE11.003",
            "comment": "Reaction Type"
          }
        ]
      },
      {
        "id": "AllergyIntolerance.category",
        "path": "AllergyIntolerance.category",
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.criticality",
        "path": "AllergyIntolerance.criticality",
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.code",
        "path": "AllergyIntolerance.code",
        "constraint": [
          {
            "key": "ca-baseline-allergy",
            "severity": "error",
            "human": "AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept",
            "expression": "AllergyIntolerance.code.coding.where(system = 'https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor').exists() or AllergyIntolerance.verificationStatus.exists()",
            "xpath": "f:code/f:coding/f:system/@value='https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor' or exists(f:verificationStatus)",
            "source": "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-allergyintolerance"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.code.coding",
        "path": "AllergyIntolerance.code.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "system"
            }
          ],
          "rules": "closed"
        },
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.code.coding:NotAsked",
        "path": "AllergyIntolerance.code.coding",
        "sliceName": "NotAsked",
        "short": "Code for NOT asked or NOT possible to obtain information about allergy or intolerance",
        "definition": "Code for the case when a patient has NOT been asked or it is NOT possible to obtain information about any history of allergy or intolerance.",
        "comment": "The binding strength of this element is [Preferred](https://www.hl7.org/fhir/terminologies.html#strength), meaning that codes are encouraged to draw from the NullFlavor value set for interoperability purposes but are not required to do so to be considered conformant.",
        "max": "1",
        "constraint": [
          {
            "key": "ca-baseline-allergy-notasked",
            "severity": "error",
            "human": "if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.verificationStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present",
            "expression": "AllergyIntolerance.code.coding.where(system = 'https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor').exists() implies (AllergyIntolerance.verificationStatus.exists().not() and AllergyIntolerance.type.exists().not() and AllergyIntolerance.category.exists().not() and AllergyIntolerance.criticality.exists().not())",
            "xpath": "f:code/f:coding/f:system/@value='https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor' and exists(f:verificationStatus).not() and exists(f:type).not() and exists(f:category).not() and exists(f:criticality).not()",
            "source": "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-allergyintolerance"
          }
        ],
        "binding": {
          "strength": "preferred",
          "description": "Negation/exclusion codes for reporting no known allergies or not available data.",
          "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor"
        }
      },
      {
        "id": "AllergyIntolerance.code.coding:NotAsked.system",
        "path": "AllergyIntolerance.code.coding.system",
        "min": 1,
        "fixedUri": "http://hl7.org/fhir/v3/NullFlavor"
      },
      {
        "id": "AllergyIntolerance.code.coding:NotAsked.code",
        "path": "AllergyIntolerance.code.coding.code",
        "min": 1
      },
      {
        "id": "AllergyIntolerance.code.coding:NoAllergy",
        "path": "AllergyIntolerance.code.coding",
        "sliceName": "NoAllergy",
        "short": "Code when a patient has been asked and has indicated no history of allergies or intolerance",
        "definition": "Code for the case when a patient has been asked and has indicated no history of allergies or intolerance.",
        "max": "1",
        "constraint": [
          {
            "key": "ca-baseline-allergy-noallergy",
            "severity": "error",
            "human": "if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error",
            "expression": "AllergyIntolerance.code.coding.where(system = 'http://snomed.info/sct' and code = '716186003').exists() and AllergyIntolerance.verificationStatus.coding.where(code = 'unconfirmed').empty()",
            "xpath": "f:code/f:coding/f:system/@value='http://snomed.info/sct' and exists(f:verificationStatus/f:coding/f:code/@value='unconfirmed').not()",
            "source": "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-allergyintolerance"
          }
        ],
        "binding": {
          "strength": "required",
          "description": "Negation/exclusion codes for reporting no known allergies",
          "valueSet": "http://snomed.info/sct"
        }
      },
      {
        "id": "AllergyIntolerance.code.coding:NoAllergy.system",
        "path": "AllergyIntolerance.code.coding.system",
        "min": 1,
        "fixedUri": "http://snomed.info/sct"
      },
      {
        "id": "AllergyIntolerance.code.coding:NoAllergy.code",
        "path": "AllergyIntolerance.code.coding.code",
        "min": 1,
        "fixedCode": "716186003"
      },
      {
        "id": "AllergyIntolerance.code.coding:@default",
        "path": "AllergyIntolerance.code.coding",
        "sliceName": "@default",
        "definition": "Code for an allergy or intolerance statement. This may be a code for a substance or pharmaceutical product that is considered to be responsible for the adverse reaction risk, an allergy or intolerance condition.",
        "comment": "The binding strength of this element is [Example](https://hl7.org/fhir/R4/terminologies.html#example), meaning that codes are not expected or even encouraged to draw from the specified value set to be conformant",
        "max": "1",
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "AllergyIntoleranceCode"
            }
          ],
          "strength": "example",
          "description": "Type of the substance/product, allergy or intolerance condition.",
          "valueSet": "http://hl7.org/fhir/ValueSet/allergyintolerance-code"
        }
      },
      {
        "id": "AllergyIntolerance.patient",
        "path": "AllergyIntolerance.patient",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.encounter",
        "path": "AllergyIntolerance.encounter",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter"
            ]
          }
        ]
      },
      {
        "id": "AllergyIntolerance.onset[x]",
        "path": "AllergyIntolerance.onset[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ]
        },
        "definition": "BASE RESOURCE DEFINITION:\r\nEstimated or actual date,  date-time, or age when allergy or intolerance was identified.\r\n\r\nCDS-S PROFILE DEFINITION:\r\n(AllergyIntolerance.onset.onsetString) - The life stage of the patient when he/she has been identified as being allergic or having an adverse reaction to a drug or a non-drug.",
        "type": [
          {
            "code": "dateTime"
          },
          {
            "code": "Age",
            "profile": [
              "https://simplifier.net/omd-cdss/onsetage"
            ]
          },
          {
            "code": "Period"
          },
          {
            "code": "Range"
          },
          {
            "code": "string"
          }
        ],
        "mustSupport": true,
        "mapping": [
          {
            "identity": "CDSS5.1",
            "map": "DE11.005",
            "comment": "Life Stage"
          }
        ]
      },
      {
        "id": "AllergyIntolerance.onset[x]:onsetDateTime",
        "path": "AllergyIntolerance.onset[x]",
        "sliceName": "onsetDateTime",
        "definition": "BASE RESOURCE DEFINITION:\r\nEstimated or actual date,  date-time, or age when allergy or intolerance was identified.\r\n\r\nCDS-S PROFILE DEFINITION:\r\nThe date that the patient reported or has been identified as being allergic or having an adverse reaction to a drug or non-drug.",
        "comment": "CODE SET TABLE: \r\nCT-016: Life Stage",
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "mustSupport": true,
        "mapping": [
          {
            "identity": "CDSS5.1",
            "map": "DE11.004",
            "comment": "Start Date"
          }
        ]
      },
      {
        "id": "AllergyIntolerance.recordedDate",
        "path": "AllergyIntolerance.recordedDate",
        "definition": "BASE RESOURCE DEFINITION:\r\nThe recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date.\r\n\r\nCDS-S PROFILE DEFINITION:\r\nThe date that the allergy or adverse reaction was recorded in the EMR.",
        "mapping": [
          {
            "identity": "CDSS5.1",
            "map": "DE11.008",
            "comment": "Recorded Date"
          }
        ]
      },
      {
        "id": "AllergyIntolerance.recorder",
        "path": "AllergyIntolerance.recorder",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner",
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole",
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient"
            ]
          }
        ]
      },
      {
        "id": "AllergyIntolerance.asserter",
        "path": "AllergyIntolerance.asserter",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient",
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner",
              "http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole"
            ]
          }
        ]
      },
      {
        "id": "AllergyIntolerance.note",
        "path": "AllergyIntolerance.note",
        "definition": "BASE RESOURCE DEFINITION:\r\nAdditional narrative about the propensity for the Adverse Reaction, not captured in other fields.\r\n\r\nCDS-S PROFILE DEFINITION:\r\nAdditional notes about an allergy or adverse reaction.",
        "mapping": [
          {
            "identity": "CDSS5.1",
            "map": "DE11.009",
            "comment": "Notes"
          }
        ]
      },
      {
        "id": "AllergyIntolerance.reaction",
        "path": "AllergyIntolerance.reaction",
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.reaction.substance",
        "path": "AllergyIntolerance.reaction.substance",
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.reaction.substance.coding",
        "path": "AllergyIntolerance.reaction.substance.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "system"
            }
          ],
          "rules": "closed"
        },
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.reaction.substance.coding:NonDrugAllergen",
        "path": "AllergyIntolerance.reaction.substance.coding",
        "sliceName": "NonDrugAllergen",
        "short": "Code for the specific non-drug allergen",
        "definition": "Code for the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction.",
        "comment": "The binding strength of this element is [Preferred](https://www.hl7.org/fhir/terminologies.html#strength), meaning that codes are encouraged to draw from the NonDrugAllergenCode value set for interoperability purposes but are not required to do so to be considered conformant.",
        "binding": {
          "strength": "preferred",
          "description": "Represents the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction.",
          "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode"
        }
      },
      {
        "id": "AllergyIntolerance.reaction.substance.coding:NonDrugAllergen.system",
        "path": "AllergyIntolerance.reaction.substance.coding.system",
        "min": 1
      },
      {
        "id": "AllergyIntolerance.reaction.substance.coding:NonDrugAllergen.code",
        "path": "AllergyIntolerance.reaction.substance.coding.code",
        "min": 1
      },
      {
        "id": "AllergyIntolerance.reaction.substance.coding:CCDD",
        "path": "AllergyIntolerance.reaction.substance.coding",
        "sliceName": "CCDD",
        "short": "Medicinal products for prescribing",
        "definition": "The subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada.",
        "comment": "The binding strength of this element is [Preferred](https://www.hl7.org/fhir/terminologies.html#strength), meaning that codes are encouraged to draw from the PrescriptionMedicinalProduct value set for interoperability purposes but are not required to do so to be considered conformant.",
        "binding": {
          "strength": "preferred",
          "description": "Represents subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada.",
          "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct"
        }
      },
      {
        "id": "AllergyIntolerance.reaction.substance.coding:CCDD.system",
        "path": "AllergyIntolerance.reaction.substance.coding.system",
        "min": 1,
        "fixedUri": "https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset"
      },
      {
        "id": "AllergyIntolerance.reaction.substance.coding:CCDD.code",
        "path": "AllergyIntolerance.reaction.substance.coding.code",
        "min": 1
      },
      {
        "id": "AllergyIntolerance.reaction.substance.coding:@default",
        "path": "AllergyIntolerance.reaction.substance.coding",
        "sliceName": "@default",
        "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.",
        "comment": "The binding strength of this element is [Example](https://hl7.org/fhir/R4/terminologies.html#example), meaning that codes are not expected or even encouraged to draw from the specified value set to be conformant",
        "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"
        }
      },
      {
        "id": "AllergyIntolerance.reaction.substance.text",
        "path": "AllergyIntolerance.reaction.substance.text",
        "definition": "BASE RESOURCE DEFINITION:\r\nA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.\r\n\r\nCDS-S PROFILE DEFINITION:\r\nThe name of the offending agent, whether drug or non-drug.",
        "mustSupport": true,
        "mapping": [
          {
            "identity": "CDSS5.1",
            "map": "DE11.001",
            "comment": "Offending Agent"
          }
        ]
      },
      {
        "id": "AllergyIntolerance.reaction.manifestation",
        "path": "AllergyIntolerance.reaction.manifestation",
        "mustSupport": true
      },
      {
        "id": "AllergyIntolerance.reaction.severity",
        "path": "AllergyIntolerance.reaction.severity",
        "definition": "BASE RESOURCE DEFINITION:\r\nClinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations.\r\n\r\nCDS-S PROFILE DEFINITION:\r\nThe severity of the allery or adverse reaction as identified by the provider.",
        "mustSupport": true,
        "mapping": [
          {
            "identity": "CDSS5.1",
            "map": "DE11.006",
            "comment": "Severity"
          }
        ]
      },
      {
        "id": "AllergyIntolerance.reaction.exposureRoute",
        "path": "AllergyIntolerance.reaction.exposureRoute",
        "comment": "The binding strength of this element is [Preferred](https://www.hl7.org/fhir/terminologies.html#strength), meaning that codes are encouraged to draw from the RouteOfAdministration value set for interoperability purposes but are not required to do so to be considered conformant.",
        "binding": {
          "strength": "preferred",
          "valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration"
        }
      },
      {
        "id": "AllergyIntolerance.reaction.note",
        "path": "AllergyIntolerance.reaction.note",
        "definition": "BASE RESOURCE DEFINITION:\r\nAdditional text about the adverse reaction event not captured in other fields.\r\n\r\nCDS-S PROFILE DEFINITION:\r\nThe description of the patient's reaction to a drug or a non-drug (e.g., rash, lip, swelling).",
        "mustSupport": true,
        "mapping": [
          {
            "identity": "CDSS5.1",
            "map": "DE11.007",
            "comment": "Reaction Description"
          }
        ]
      }
    ]
  }
}