<status value="draft" /> <date value="2021-10-24T23:10:10.7705133+00:00" /> <publisher value="OMD" /> <description value="Proposed constraints and extensions on the AllergyIntolerance Resource" /> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166" /> <code value="CA" /> <display value="Canada" /> </coding> </jurisdiction> <fhirVersion value="4.0.1" /> <mapping> <identity value="CDSS5.1" /> <uri value="www.ontariomd.com" /> <name value="CDS-S 5.1" /> </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"> <path value="AllergyIntolerance" /> <short value="AllergyIntolerance Profile" /> <definition value="The AllergyIntolerance Profile is based upon the core FHIR AllergyIntolerance Resource" /> </element> <element id="AllergyIntolerance.identifier"> <path value="AllergyIntolerance.identifier" /> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.clinicalStatus"> <path value="AllergyIntolerance.clinicalStatus" /> <mustSupport value="true" /> <isModifierReason value="This element is labeled as a modifier because the status contains the codes refuted and entered-in-error that mark the AllergyIntolerance as not currently valid." /> </element> <element id="AllergyIntolerance.verificationStatus"> <path value="AllergyIntolerance.verificationStatus" /> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.verificationStatus.coding"> <path value="AllergyIntolerance.verificationStatus.coding" /> <slicing> <discriminator> <type value="value" /> <path value="system" /> </discriminator> <rules value="closed" /> </slicing> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.verificationStatus.coding:StatusCode"> <path value="AllergyIntolerance.verificationStatus.coding" /> <sliceName value="StatusCode" /> <short value="Code for allergy or intolerance status" /> <definition value="Code for an allergy or intolerance statement. Represents whether an allergy/intolerance is active or resolved (indicating no longer active)." /> <comment value="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 value="1" /> <binding> <strength value="preferred" /> <description value="Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance." /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/allergyintolerancestatuscode" /> </binding> </element> <element id="AllergyIntolerance.verificationStatus.coding:StatusCode.system"> <path value="AllergyIntolerance.verificationStatus.coding.system" /> <min value="1" /> </element> <element id="AllergyIntolerance.verificationStatus.coding:StatusCode.code"> <path value="AllergyIntolerance.verificationStatus.coding.code" /> <min value="1" /> </element> <element id="AllergyIntolerance.verificationStatus.coding:@default"> <path value="AllergyIntolerance.verificationStatus.coding" /> <sliceName value="@default" /> <definition value="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 value="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 value="1" /> <max value="1" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AllergyIntoleranceVerificationStatus" /> </extension> <strength value="required" /> <description value="Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance." /> <valueSet value="http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1" /> </binding> </element> <element id="AllergyIntolerance.verificationStatus.coding:@default.system"> <path value="AllergyIntolerance.verificationStatus.coding.system" /> <min value="1" /> <fixedUri value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" /> </element> <element id="AllergyIntolerance.verificationStatus.coding:@default.code"> <path value="AllergyIntolerance.verificationStatus.coding.code" /> <min value="1" /> </element> <element id="AllergyIntolerance.type"> <path value="AllergyIntolerance.type" /> <definition value="BASE RESOURCE DEFINITION: Identification of the underlying physiological mechanism for the reaction risk. CDS-S PROFILE DEFINITION: Identifies whether the reaction is an allergy or an adverse reaction (including intolerance and side effects)." /> <mapping> <identity value="CDSS5.1" /> <map value="DE11.003" /> <comment value="Reaction Type" /> </mapping> </element> <element id="AllergyIntolerance.category"> <path value="AllergyIntolerance.category" /> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.criticality"> <path value="AllergyIntolerance.criticality" /> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.code"> <path value="AllergyIntolerance.code" /> <constraint> <key value="ca-baseline-allergy" /> <severity value="error" /> <human value="AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept" /> <expression value="AllergyIntolerance.code.coding.where(system = 'https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor').exists() or AllergyIntolerance.verificationStatus.exists()" /> <xpath value="f:code/f:coding/f:system/@value='https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor' or exists(f:verificationStatus)" /> <source value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-allergyintolerance" /> </constraint> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.code.coding"> <path value="AllergyIntolerance.code.coding" /> <slicing> <discriminator> <type value="value" /> <path value="system" /> </discriminator> <rules value="closed" /> </slicing> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.code.coding:NotAsked"> <path value="AllergyIntolerance.code.coding" /> <sliceName value="NotAsked" /> <short value="Code for NOT asked or NOT possible to obtain information about allergy or intolerance" /> <definition value="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 value="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 value="1" /> <constraint> <key value="ca-baseline-allergy-notasked" /> <severity value="error" /> <human value="if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.verificationStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present" /> <expression value="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 value="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 value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-allergyintolerance" /> </constraint> <binding> <strength value="preferred" /> <description value="Negation/exclusion codes for reporting no known allergies or not available data." /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor" /> </binding> </element> <element id="AllergyIntolerance.code.coding:NotAsked.system"> <path value="AllergyIntolerance.code.coding.system" /> <min value="1" /> <fixedUri value="http://hl7.org/fhir/v3/NullFlavor" /> </element> <element id="AllergyIntolerance.code.coding:NotAsked.code"> <path value="AllergyIntolerance.code.coding.code" /> <min value="1" /> </element> <element id="AllergyIntolerance.code.coding:NoAllergy"> <path value="AllergyIntolerance.code.coding" /> <sliceName value="NoAllergy" /> <short value="Code when a patient has been asked and has indicated no history of allergies or intolerance" /> <definition value="Code for the case when a patient has been asked and has indicated no history of allergies or intolerance." /> <max value="1" /> <constraint> <key value="ca-baseline-allergy-noallergy" /> <severity value="error" /> <human value="if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error" /> <expression value="AllergyIntolerance.code.coding.where(system = 'http://snomed.info/sct' and code = '716186003').exists() and AllergyIntolerance.verificationStatus.coding.where(code = 'unconfirmed').empty()" /> <xpath value="f:code/f:coding/f:system/@value='http://snomed.info/sct' and exists(f:verificationStatus/f:coding/f:code/@value='unconfirmed').not()" /> <source value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-allergyintolerance" /> </constraint> <binding> <strength value="required" /> <description value="Negation/exclusion codes for reporting no known allergies" /> <valueSet value="http://snomed.info/sct" /> </binding> </element> <element id="AllergyIntolerance.code.coding:NoAllergy.system"> <path value="AllergyIntolerance.code.coding.system" /> <min value="1" /> <fixedUri value="http://snomed.info/sct" /> </element> <element id="AllergyIntolerance.code.coding:NoAllergy.code"> <path value="AllergyIntolerance.code.coding.code" /> <min value="1" /> <fixedCode value="716186003" /> </element> <element id="AllergyIntolerance.code.coding:@default"> <path value="AllergyIntolerance.code.coding" /> <sliceName value="@default" /> <definition value="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 value="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 value="1" /> <binding> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName"> <valueString value="AllergyIntoleranceCode" /> </extension> <strength value="example" /> <description value="Type of the substance/product, allergy or intolerance condition." /> <valueSet value="http://hl7.org/fhir/ValueSet/allergyintolerance-code" /> </binding> </element> <element id="AllergyIntolerance.patient"> <path value="AllergyIntolerance.patient" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient" /> </type> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.encounter"> <path value="AllergyIntolerance.encounter" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter" /> </type> </element> <element id="AllergyIntolerance.onset[x]"> <path value="AllergyIntolerance.onset[x]" /> <slicing> <discriminator> <type value="type" /> <path value="$this" /> </discriminator> </slicing> <definition value="BASE RESOURCE DEFINITION: Estimated or actual date, date-time, or age when allergy or intolerance was identified. CDS-S PROFILE DEFINITION: (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 value="dateTime" /> </type> <type> <code value="Age" /> <profile value="https://simplifier.net/omd-cdss/onsetage" /> </type> <type> <code value="Period" /> </type> <type> <code value="Range" /> </type> <type> <code value="string" /> </type> <mustSupport value="true" /> <mapping> <identity value="CDSS5.1" /> <map value="DE11.005" /> <comment value="Life Stage" /> </mapping> </element> <element id="AllergyIntolerance.onset[x]:onsetDateTime"> <path value="AllergyIntolerance.onset[x]" /> <sliceName value="onsetDateTime" /> <definition value="BASE RESOURCE DEFINITION: Estimated or actual date, date-time, or age when allergy or intolerance was identified. CDS-S PROFILE DEFINITION: The date that the patient reported or has been identified as being allergic or having an adverse reaction to a drug or non-drug." /> <comment value="CODE SET TABLE: CT-016: Life Stage" /> <type> <code value="dateTime" /> </type> <mustSupport value="true" /> <mapping> <identity value="CDSS5.1" /> <map value="DE11.004" /> <comment value="Start Date" /> </mapping> </element> <element id="AllergyIntolerance.recordedDate"> <path value="AllergyIntolerance.recordedDate" /> <definition value="BASE RESOURCE DEFINITION: The recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date. CDS-S PROFILE DEFINITION: The date that the allergy or adverse reaction was recorded in the EMR." /> <mapping> <identity value="CDSS5.1" /> <map value="DE11.008" /> <comment value="Recorded Date" /> </mapping> </element> <element id="AllergyIntolerance.recorder"> <path value="AllergyIntolerance.recorder" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner" /> <targetProfile value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole" /> <targetProfile value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient" /> </type> </element> <element id="AllergyIntolerance.asserter"> <path value="AllergyIntolerance.asserter" /> <type> <code value="Reference" /> <targetProfile value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient" /> <targetProfile value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner" /> <targetProfile value="http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole" /> </type> </element> <element id="AllergyIntolerance.note"> <path value="AllergyIntolerance.note" /> <definition value="BASE RESOURCE DEFINITION: Additional narrative about the propensity for the Adverse Reaction, not captured in other fields. CDS-S PROFILE DEFINITION: Additional notes about an allergy or adverse reaction." /> <mapping> <identity value="CDSS5.1" /> <map value="DE11.009" /> <comment value="Notes" /> </mapping> </element> <element id="AllergyIntolerance.reaction"> <path value="AllergyIntolerance.reaction" /> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.reaction.substance"> <path value="AllergyIntolerance.reaction.substance" /> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.reaction.substance.coding"> <path value="AllergyIntolerance.reaction.substance.coding" /> <slicing> <discriminator> <type value="value" /> <path value="system" /> </discriminator> <rules value="closed" /> </slicing> <min value="1" /> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.reaction.substance.coding:NonDrugAllergen"> <path value="AllergyIntolerance.reaction.substance.coding" /> <sliceName value="NonDrugAllergen" /> <short value="Code for the specific non-drug allergen" /> <definition value="Code for the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction." /> <comment value="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 value="preferred" /> <description value="Represents the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction." /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode" /> </binding> </element> <element id="AllergyIntolerance.reaction.substance.coding:NonDrugAllergen.system"> <path value="AllergyIntolerance.reaction.substance.coding.system" /> <min value="1" /> </element> <element id="AllergyIntolerance.reaction.substance.coding:NonDrugAllergen.code"> <path value="AllergyIntolerance.reaction.substance.coding.code" /> <min value="1" /> </element> <element id="AllergyIntolerance.reaction.substance.coding:CCDD"> <path value="AllergyIntolerance.reaction.substance.coding" /> <sliceName value="CCDD" /> <short value="Medicinal products for prescribing" /> <definition value="The subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada." /> <comment value="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 value="preferred" /> <description value="Represents subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada." /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct" /> </binding> </element> <element id="AllergyIntolerance.reaction.substance.coding:CCDD.system"> <path value="AllergyIntolerance.reaction.substance.coding.system" /> <min value="1" /> <fixedUri value="https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset" /> </element> <element id="AllergyIntolerance.reaction.substance.coding:CCDD.code"> <path value="AllergyIntolerance.reaction.substance.coding.code" /> <min value="1" /> </element> <element id="AllergyIntolerance.reaction.substance.coding:@default"> <path value="AllergyIntolerance.reaction.substance.coding" /> <sliceName value="@default" /> <short value="Specific substance or pharmaceutical product considered to be responsible for event" /> <definition value="Identification of the specific substance (or pharmaceutical product) considered to be responsible for the Adverse Reaction event." /> <comment value="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 value="SubstanceCode" /> </extension> <strength value="example" /> <description value="Codes defining the type of the substance (including pharmaceutical products)." /> <valueSet value="http://hl7.org/fhir/ValueSet/substance-code" /> </binding> </element> <element id="AllergyIntolerance.reaction.substance.text"> <path value="AllergyIntolerance.reaction.substance.text" /> <definition value="BASE RESOURCE DEFINITION: A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user. CDS-S PROFILE DEFINITION: The name of the offending agent, whether drug or non-drug." /> <mustSupport value="true" /> <mapping> <identity value="CDSS5.1" /> <map value="DE11.001" /> <comment value="Offending Agent" /> </mapping> </element> <element id="AllergyIntolerance.reaction.manifestation"> <path value="AllergyIntolerance.reaction.manifestation" /> <mustSupport value="true" /> </element> <element id="AllergyIntolerance.reaction.severity"> <path value="AllergyIntolerance.reaction.severity" /> <definition value="BASE RESOURCE DEFINITION: Clinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations. CDS-S PROFILE DEFINITION: The severity of the allery or adverse reaction as identified by the provider." /> <mustSupport value="true" /> <mapping> <identity value="CDSS5.1" /> <map value="DE11.006" /> <comment value="Severity" /> </mapping> </element> <element id="AllergyIntolerance.reaction.exposureRoute"> <path value="AllergyIntolerance.reaction.exposureRoute" /> <comment value="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 value="preferred" /> <valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration" /> </binding> </element> <element id="AllergyIntolerance.reaction.note"> <path value="AllergyIntolerance.reaction.note" /> <definition value="BASE RESOURCE DEFINITION: Additional text about the adverse reaction event not captured in other fields. CDS-S PROFILE DEFINITION: The description of the patient's reaction to a drug or a non-drug (e.g., rash, lip, swelling)." /> <mustSupport value="true" /> <mapping> <identity value="CDSS5.1" /> <map value="DE11.007" /> <comment value="Reaction Description" /> </mapping> </element> </differential> </StructureDefinition>