Allergy (Patient Dossier)
1.1.0 - STU1

This page is part of the HL7 Belgium FHIR Implementation Guide - Allergy profiles (v1.1.0: Release) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: BeAllergyIntolerance - Detailed Descriptions

Active as of 2023-02-06 Maturity Level: 1

Definitions for the be-allergyintolerance resource profile.

Guidance on how to interpret the contents of this table can be found here.

1. AllergyIntolerance
InvariantsDefined on this element
be-inv-asserter-person-rel-type: Checks that the person relationship type of the RelatedPerson in asserter is from BeVSPatientRelationshipType (: asserter.empty() or (asserter.resolve() is RelatedPerson implies asserter.resolve().relationship.memberOf('https://www.ehealth.fgov.be/standards/fhir/core/ValueSet/be-vs-patient-relationship-type')))
2. AllergyIntolerance.extension
SlicingThis element introduces a set of slices on AllergyIntolerance.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
3. AllergyIntolerance.extension:type
SliceNametype
Control0..1
TypeExtension(BeExtAllergyType) (Extension Type: CodeableConcept)
Must Supporttrue
4. AllergyIntolerance.identifier
NoteThis is a business identifier, not a resource identifier (see discussion)
Must Supporttrue
SlicingThis element introduces a set of slices on AllergyIntolerance.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
5. AllergyIntolerance.identifier:allergy
SliceNameallergy
NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
6. AllergyIntolerance.identifier:allergy.system
Control1..?
Fixed Valuehttps://www.ehealth.fgov.be/standards/fhir/allergy/NamingSystem/be-ns-allergy
7. AllergyIntolerance.identifier:allergy.value
Control1..?
8. AllergyIntolerance.clinicalStatus
Definition

The clinical status of the allergy or intolerance.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

Use 'resolved' only in case of pediatric allergies, in case of complete recovery, use 'inactive' in case of longlasting tolerance after a desensitisation treatment

Must Supporttrue
9. AllergyIntolerance.verificationStatus
Definition

Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

Must Supporttrue
10. AllergyIntolerance.type
Control0..01
11. AllergyIntolerance.category
Definition

Category of the identified substance.

When available, a provider SHOULD include it in the istance. When given, a consumer SHALL record this in its consuming system.

Must Supporttrue
12. AllergyIntolerance.code
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 (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a general or categorical negated statement (e.g., "No known allergy"). 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.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system. Medication related allergies or intolerances will be registered using the CNK, ATC or CTI-extended namingsystem.

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.

Control10..1
BindingThe codes SHALL be taken from BeAllergyIntoleranceCode; other codes may be used where these codes are not suitableFor example codes, see AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes

Causative agent codes as defined by NIHDI

Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.

Must Supporttrue
Comments

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 (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a general or categorical negated statement (e.g., "No known allergy"). 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.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system. Medication related allergies or intolerances will be registered using the CNK, ATC or CTI-extended namingsystem.

It is strongly recommended that this element be populated using a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNII, and ATC. Plain text should only be used if there is no appropriate terminology available. Additional details can be specified in the text.

When a substance or product code is specified for the 'code' element, the "default" semantic context is that this is a positive statement of an allergy or intolerance (depending on the value of the 'type' element, if present) condition to the specified substance/product. In the corresponding SNOMED CT allergy model, the specified substance/product is the target (destination) of the "Causative agent" relationship.

The 'substanceExposureRisk' extension is available as a structured and more flexible alternative to the 'code' element for making positive or negative allergy or intolerance statements. This extension provides the capability to make "no known allergy" (or "no risk of adverse reaction") statements regarding any coded substance/product (including cases when a pre-coordinated "no allergy to x" concept for that substance/product does not exist). If the 'substanceExposureRisk' extension is present, the AllergyIntolerance.code element SHALL be omitted.

13. AllergyIntolerance.patient
Definition

The patient who has the allergy or intolerance.

A provider SHALL include it in the istance and a consumer SHALL record this in its consuming system.

TypeReference(BePatient|Patient)
Must Supporttrue
14. AllergyIntolerance.recordedDate
Definition

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

A provider SHALL include it in the istance and a consumer SHALL record this in its consuming system.

Control10..1
Must Supporttrue
15. AllergyIntolerance.recorder
Definition

Individual who takes responsibility for the content of the record. BePatient is added to allow a patient to record his/her own allergies. Organisations can be a recorder, using a PractitionerRole, but the you SHALL add a BePractioner who is responsable for the organisation.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system.

Individual who recorded the record and takes responsibility for its content.

Control10..1
TypeReference(BePractitioner|BePractitionerRole|BePatient|Practitioner|PractitionerRole|Patient|RelatedPerson)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Special remarks for KMEHR users: This is the 'author' concept in a KMEHR message as the FHIR recorder is the party taking responsibility.

16. AllergyIntolerance.asserter
Definition

The source of the information about the allergy that is recorded.

When available, a provider SHOULD include it in the instance. When given, a consumer SHALL record this in its consuming system.

Must Supporttrue
Comments

The recorder takes responsibility for the content, but can reference the source from where they got it.

Special remarks for KMEHR users: As the FHIR asserter is not the party taking responsibility, this is not equal to the 'author' concept in KMEHR.

17. AllergyIntolerance.note
Must Supporttrue
Comments

For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

18. AllergyIntolerance.reaction
Definition

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

When available, a provider SHOULD include it in the istance. When given, a consumer SHALL record this in its consuming system.

Must Supporttrue
19. AllergyIntolerance.reaction.substance
20. AllergyIntolerance.reaction.manifestation
Definition

Clinical symptoms and/or signs that are observed or associated with the adverse reaction event.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system. If needed codes can be used outside the given valueset, SNOMED-CT is preferred.

Control1..1*
BindingThe codes SHALL be taken from BeRiskManifestation; other codes may be used where these codes are not suitableFor example codes, see SNOMEDCTClinicalFindings
Must Supporttrue
21. AllergyIntolerance.reaction.onset
Must Supporttrue
22. AllergyIntolerance.reaction.exposureRoute
Definition

Identification of the route by which the subject was exposed to the substance. If needed codes can be used outside the given valueset, SNOMED-CT is preferred.

Identification of the route by which the subject was exposed to the substance.

BindingThe codes SHALL be taken from BeExposureRoute; other codes may be used where these codes are not suitableFor example codes, see SNOMEDCTRouteCodes
23. AllergyIntolerance.reaction.note
Definition

Additional text about the adverse reaction event not captured in other fields.

A note on this level SHOULD be avoided when not absolutely necessary. Preferably use the .note one level higher.

Guidance on how to interpret the contents of this table can be found here.

1. AllergyIntolerance
Definition

Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.

Control0..*
Summaryfalse
Alternate NamesAllergy, Intolerance, Adverse Reaction
Comments

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

InvariantsDefined on this element
ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. (: verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists())
ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (: verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty())
be-inv-asserter-person-rel-type: Checks that the person relationship type of the RelatedPerson in asserter is from BeVSPatientRelationshipType (: asserter.empty() or (asserter.resolve() is RelatedPerson implies asserter.resolve().relationship.memberOf('https://www.ehealth.fgov.be/standards/fhir/core/ValueSet/be-vs-patient-relationship-type')))
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (: contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (: contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (: text.`div`.exists())
2. AllergyIntolerance.implicitRules
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.

Control0..1
Typeuri
Is Modifiertrue
Summarytrue
Comments

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
3. AllergyIntolerance.extension
Definition

An Extension

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.

Control0..*
TypeExtension
Summaryfalse
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on AllergyIntolerance.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
4. AllergyIntolerance.extension:type
SliceNametype
Definition

extension to be replaced by http://hl7.org/fhir/5.0/StructureDefinition/extension-AllergyIntolerance.type. If possible, the semantic contents of this field SHALL be identical to AllergyIntolerance.type. If not possible AllergyIntolerance SHALL be null.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(BeExtAllergyType) (Extension Type: CodeableConcept)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
5. AllergyIntolerance.modifierExtension
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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Summaryfalse
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.

Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
6. AllergyIntolerance.identifier
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.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Must Supporttrue
Summarytrue
Requirements

Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on AllergyIntolerance.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
7. AllergyIntolerance.identifier:allergy
SliceNameallergy
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.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1*
TypeIdentifier
Summarytrue
Requirements

Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
8. AllergyIntolerance.identifier:allergy.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse

Identifies the purpose for this identifier, if known .

Typecode
Is Modifiertrue
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
9. AllergyIntolerance.identifier:allergy.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control10..1
Typeuri
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Fixed Valuehttps://www.ehealth.fgov.be/standards/fhir/allergy/NamingSystem/be-ns-allergy
Example
General:http://www.acme.com/identifiers/patient
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
10. AllergyIntolerance.identifier:allergy.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control10..1
Typestring
Summarytrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Example
General:123456
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
11. AllergyIntolerance.clinicalStatus
Definition

The clinical status of the allergy or intolerance.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

Use 'resolved' only in case of pediatric allergies, in case of complete recovery, use 'inactive' in case of longlasting tolerance after a desensitisation treatment

Control0..1 This element is affected by the following invariants: ait-1, ait-2
BindingThe codes SHALL be taken from AllergyIntoleranceClinicalStatusCodes

The clinical status of the allergy or intolerance.

TypeCodeableConcept
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

Refer to discussion if clincalStatus is missing data. The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
12. AllergyIntolerance.verificationStatus
Definition

Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

Control0..1 This element is affected by the following invariants: ait-1, ait-2
BindingThe codes SHALL be taken from AllergyIntoleranceVerificationStatusCodes

Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.

TypeCodeableConcept
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
13. AllergyIntolerance.type
Definition

Identification of the underlying physiological mechanism for the reaction risk.

Control0..01
BindingThe codes SHALL be taken from AllergyIntoleranceType

Identification of the underlying physiological mechanism for a Reaction Risk.

Typecode
Summarytrue
Alternate NamesCategory, Class
Comments

Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians might not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts might not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
14. AllergyIntolerance.category
Definition

Category of the identified substance.

When available, a provider SHOULD include it in the istance. When given, a consumer SHALL record this in its consuming system.

Control0..*
BindingThe codes SHALL be taken from AllergyIntoleranceCategory

Category of an identified substance associated with allergies or intolerances.

Typecode
Must Supporttrue
Summarytrue
Alternate NamesCategory, Type, Reaction Type, Class
Comments

This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the substance where coding systems are used, and is effectively redundant in that situation. When searching on category, consider the implications of AllergyIntolerance resources without a category. For example, when searching on category = medication, medication allergies that don't have a category valued will not be returned. Refer to search for more information on how to search category with a :missing modifier to get allergies that don't have a category. Additionally, category should be used with caution because category can be subjective based on the sender.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
15. AllergyIntolerance.code
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 (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a general or categorical negated statement (e.g., "No known allergy"). 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.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system. Medication related allergies or intolerances will be registered using the CNK, ATC or CTI-extended namingsystem.

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.

Control10..1
BindingThe codes SHALL be taken from BeAllergyIntoleranceCode; other codes may be used where these codes are not suitableFor example codes, see AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes

Causative agent codes as defined by NIHDI

Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.

TypeCodeableConcept
Must Supporttrue
Summarytrue
Alternate NamesCode
Comments

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 (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a general or categorical negated statement (e.g., "No known allergy"). 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.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system. Medication related allergies or intolerances will be registered using the CNK, ATC or CTI-extended namingsystem.

It is strongly recommended that this element be populated using a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNII, and ATC. Plain text should only be used if there is no appropriate terminology available. Additional details can be specified in the text.

When a substance or product code is specified for the 'code' element, the "default" semantic context is that this is a positive statement of an allergy or intolerance (depending on the value of the 'type' element, if present) condition to the specified substance/product. In the corresponding SNOMED CT allergy model, the specified substance/product is the target (destination) of the "Causative agent" relationship.

The 'substanceExposureRisk' extension is available as a structured and more flexible alternative to the 'code' element for making positive or negative allergy or intolerance statements. This extension provides the capability to make "no known allergy" (or "no risk of adverse reaction") statements regarding any coded substance/product (including cases when a pre-coordinated "no allergy to x" concept for that substance/product does not exist). If the 'substanceExposureRisk' extension is present, the AllergyIntolerance.code element SHALL be omitted.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. AllergyIntolerance.patient
Definition

The patient who has the allergy or intolerance.

A provider SHALL include it in the istance and a consumer SHALL record this in its consuming system.

Control1..1
TypeReference(BePatient|Patient)
Must Supporttrue
Summarytrue
Alternate NamesPatient
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. AllergyIntolerance.recordedDate
Definition

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

A provider SHALL include it in the istance and a consumer SHALL record this in its consuming system.

Control10..1
TypedateTime
Must Supporttrue
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. AllergyIntolerance.recorder
Definition

Individual who takes responsibility for the content of the record. BePatient is added to allow a patient to record his/her own allergies. Organisations can be a recorder, using a PractitionerRole, but the you SHALL add a BePractioner who is responsable for the organisation.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system.

Individual who recorded the record and takes responsibility for its content.

Control10..1
TypeReference(BePractitioner|BePractitionerRole|BePatient|Practitioner|PractitionerRole|Patient|RelatedPerson)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summaryfalse
Alternate NamesAuthor
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Special remarks for KMEHR users: This is the 'author' concept in a KMEHR message as the FHIR recorder is the party taking responsibility.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. AllergyIntolerance.asserter
Definition

The source of the information about the allergy that is recorded.

When available, a provider SHOULD include it in the instance. When given, a consumer SHALL record this in its consuming system.

Control0..1
TypeReference(Patient|RelatedPerson|Practitioner|PractitionerRole)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
Alternate NamesSource, Informant
Comments

The recorder takes responsibility for the content, but can reference the source from where they got it.

Special remarks for KMEHR users: As the FHIR asserter is not the party taking responsibility, this is not equal to the 'author' concept in KMEHR.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. AllergyIntolerance.note
Definition

Additional narrative about the propensity for the Adverse Reaction, not captured in other fields.

Control0..*
TypeAnnotation
Must Supporttrue
Summaryfalse
Comments

For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. AllergyIntolerance.reaction
Definition

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

When available, a provider SHOULD include it in the istance. When given, a consumer SHALL record this in its consuming system.

Control0..*
TypeBackboneElement
Must Supporttrue
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. AllergyIntolerance.reaction.modifierExtension
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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
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.

Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
23. AllergyIntolerance.reaction.substance
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.

Control0..1
BindingFor example codes, see SubstanceCode

Codes defining the type of the substance (including pharmaceutical products).

TypeCodeableConcept
Summaryfalse
Comments

Coding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, "penicillins"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, "amoxycillin"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. AllergyIntolerance.reaction.manifestation
Definition

Clinical symptoms and/or signs that are observed or associated with the adverse reaction event.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system. If needed codes can be used outside the given valueset, SNOMED-CT is preferred.

Control1..1*
BindingThe codes SHALL be taken from BeRiskManifestation; other codes may be used where these codes are not suitableFor example codes, see SNOMEDCTClinicalFindings
TypeCodeableConcept
Must Supporttrue
Summaryfalse
Alternate NamesSymptoms, Signs
Comments

Manifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. AllergyIntolerance.reaction.onset
Definition

Record of the date and/or time of the onset of the Reaction.

Control0..1
TypedateTime
Must Supporttrue
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. AllergyIntolerance.reaction.exposureRoute
Definition

Identification of the route by which the subject was exposed to the substance. If needed codes can be used outside the given valueset, SNOMED-CT is preferred.

Identification of the route by which the subject was exposed to the substance.

Control0..1
BindingThe codes SHALL be taken from BeExposureRoute; other codes may be used where these codes are not suitableFor example codes, see SNOMEDCTRouteCodes
TypeCodeableConcept
Summaryfalse
Comments

Coding of the route of exposure with a terminology should be used wherever possible.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. AllergyIntolerance.reaction.note
Definition

Additional text about the adverse reaction event not captured in other fields.

A note on this level SHOULD be avoided when not absolutely necessary. Preferably use the .note one level higher.

Control0..*
TypeAnnotation
Summaryfalse
Comments

Use this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be found here.

1. AllergyIntolerance
Definition

Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.

Control0..*
Summaryfalse
Alternate NamesAllergy, Intolerance, Adverse Reaction
Comments

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

2. AllergyIntolerance.id
Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Control0..1
Typeid
Summarytrue
Comments

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

3. AllergyIntolerance.meta
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.

Control0..1
TypeMeta
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
4. AllergyIntolerance.implicitRules
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.

Control0..1
Typeuri
Is Modifiertrue
Summarytrue
Comments

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
5. AllergyIntolerance.language
Definition

The base language in which the resource is written.

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages A human language
Additional BindingsPurpose
AllLanguagesMax Binding
Typecode
Summaryfalse
Comments

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).

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
6. AllergyIntolerance.text
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.

Control0..1
TypeNarrative
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Comments

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.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
7. AllergyIntolerance.contained
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.

Control0..*
TypeResource
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
Comments

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.

8. AllergyIntolerance.extension
Definition

An Extension

Control0..*
TypeExtension
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on AllergyIntolerance.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
9. AllergyIntolerance.extension:type
SliceNametype
Definition

extension to be replaced by http://hl7.org/fhir/5.0/StructureDefinition/extension-AllergyIntolerance.type. If possible, the semantic contents of this field SHALL be identical to AllergyIntolerance.type. If not possible AllergyIntolerance SHALL be null.

Control0..1 This element is affected by the following invariants: ele-1
TypeExtension(BeExtAllergyType) (Extension Type: CodeableConcept)
Must Supporttrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
10. AllergyIntolerance.modifierExtension
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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Summaryfalse
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.

Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
11. AllergyIntolerance.identifier
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.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..*
TypeIdentifier
Must Supporttrue
Summarytrue
Requirements

Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on AllergyIntolerance.identifier. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ system
12. AllergyIntolerance.identifier:allergy
SliceNameallergy
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.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control0..1
TypeIdentifier
Summarytrue
Requirements

Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
13. AllergyIntolerance.identifier:allergy.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
14. AllergyIntolerance.identifier:allergy.extension
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.

Control0..*
TypeExtension
Summaryfalse
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
SlicingThis element introduces a set of slices on AllergyIntolerance.identifier.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
15. AllergyIntolerance.identifier:allergy.use
Definition

The purpose of this identifier.

Control0..1
BindingThe codes SHALL be taken from IdentifierUse Identifies the purpose for this identifier, if known
Typecode
Is Modifiertrue
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
16. AllergyIntolerance.identifier:allergy.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

Control0..1
BindingThe codes SHALL be taken from Identifier Type Codes; other codes may be used where these codes are not suitable A coded type for an identifier that can be used to determine which identifier to use for a specific purpose
TypeCodeableConcept
Summarytrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
17. AllergyIntolerance.identifier:allergy.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

Control1..1
Typeuri
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

Fixed Valuehttps://www.ehealth.fgov.be/standards/fhir/allergy/NamingSystem/be-ns-allergy
Example
General:http://www.acme.com/identifiers/patient
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
18. AllergyIntolerance.identifier:allergy.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

Control1..1
Typestring
Summarytrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Example
General:123456
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
19. AllergyIntolerance.identifier:allergy.period
Definition

Time period during which identifier is/was valid for use.

Control0..1
TypePeriod
Summarytrue
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
20. AllergyIntolerance.identifier:allergy.assigner
Definition

Organization that issued/manages the identifier.

Control0..1
TypeReference(Organization)
Summarytrue
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
21. AllergyIntolerance.clinicalStatus
Definition

The clinical status of the allergy or intolerance.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

Use 'resolved' only in case of pediatric allergies, in case of complete recovery, use 'inactive' in case of longlasting tolerance after a desensitisation treatment

Control0..1 This element is affected by the following invariants: ait-1, ait-2
BindingThe codes SHALL be taken from AllergyIntoleranceClinicalStatusCodes The clinical status of the allergy or intolerance
TypeCodeableConcept
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

Refer to discussion if clincalStatus is missing data. The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
22. AllergyIntolerance.verificationStatus
Definition

Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

Control0..1 This element is affected by the following invariants: ait-1, ait-2
BindingThe codes SHALL be taken from AllergyIntoleranceVerificationStatusCodes Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance
TypeCodeableConcept
Is Modifiertrue
Must Supporttrue
Summarytrue
Comments

The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
23. AllergyIntolerance.type
Definition

Identification of the underlying physiological mechanism for the reaction risk.

Control0..0
BindingThe codes SHALL be taken from AllergyIntoleranceType Identification of the underlying physiological mechanism for a Reaction Risk
Typecode
Summarytrue
Alternate NamesCategory, Class
Comments

Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians might not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts might not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
24. AllergyIntolerance.category
Definition

Category of the identified substance.

When available, a provider SHOULD include it in the istance. When given, a consumer SHALL record this in its consuming system.

Control0..*
BindingThe codes SHALL be taken from AllergyIntoleranceCategory Category of an identified substance associated with allergies or intolerances
Typecode
Must Supporttrue
Summarytrue
Alternate NamesCategory, Type, Reaction Type, Class
Comments

This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the substance where coding systems are used, and is effectively redundant in that situation. When searching on category, consider the implications of AllergyIntolerance resources without a category. For example, when searching on category = medication, medication allergies that don't have a category valued will not be returned. Refer to search for more information on how to search category with a :missing modifier to get allergies that don't have a category. Additionally, category should be used with caution because category can be subjective based on the sender.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
25. AllergyIntolerance.criticality
Definition

Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance.

Control0..1
BindingThe codes SHALL be taken from AllergyIntoleranceCriticality Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance
Typecode
Summarytrue
Alternate NamesSeverity, Seriousness, Contra-indication, Risk
Comments

The default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). Systems that capture a severity at the condition level are actually representing the concept of criticality whereas the severity documented at the reaction level is representing the true reaction severity. Existing systems that are capturing both condition criticality and reaction severity may use the term "severity" to represent both. Criticality is the worst it could be in the future (i.e. situation-agnostic) whereas severity is situation-dependent.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
26. AllergyIntolerance.code
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 (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a general or categorical negated statement (e.g., "No known allergy"). 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.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system. Medication related allergies or intolerances will be registered using the CNK, ATC or CTI-extended namingsystem.

Control1..1
BindingThe codes SHALL be taken from BeAllergyIntoleranceCode; other codes may be used where these codes are not suitable Causative agent codes as defined by NIHD
TypeCodeableConcept
Must Supporttrue
Summarytrue
Alternate NamesCode
Comments

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 (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a general or categorical negated statement (e.g., "No known allergy"). 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.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system. Medication related allergies or intolerances will be registered using the CNK, ATC or CTI-extended namingsystem.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
27. AllergyIntolerance.patient
Definition

The patient who has the allergy or intolerance.

A provider SHALL include it in the istance and a consumer SHALL record this in its consuming system.

Control1..1
TypeReference(BePatient)
Must Supporttrue
Summarytrue
Alternate NamesPatient
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
28. AllergyIntolerance.encounter
Definition

The encounter when the allergy or intolerance was asserted.

Control0..1
TypeReference(Encounter)
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
29. AllergyIntolerance.onset[x]
Definition

Estimated or actual date, date-time, or age when allergy or intolerance was identified.

Control0..1
TypeChoice of: dateTime, Age, Period, Range, string
[x] NoteSee Choice of Data Types for further information about how to use [x]
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
30. AllergyIntolerance.recordedDate
Definition

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

A provider SHALL include it in the istance and a consumer SHALL record this in its consuming system.

Control1..1
TypedateTime
Must Supporttrue
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
31. AllergyIntolerance.recorder
Definition

Individual who takes responsibility for the content of the record. BePatient is added to allow a patient to record his/her own allergies. Organisations can be a recorder, using a PractitionerRole, but the you SHALL add a BePractioner who is responsable for the organisation.

A provider SHALL include it in the instance and a consumer SHALL record this in its consuming system.

Control1..1
TypeReference(BePractitioner|BePractitionerRole|BePatient)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summaryfalse
Alternate NamesAuthor
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Special remarks for KMEHR users: This is the 'author' concept in a KMEHR message as the FHIR recorder is the party taking responsibility.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
32. AllergyIntolerance.asserter
Definition

The source of the information about the allergy that is recorded.

When available, a provider SHOULD include it in the instance. When given, a consumer SHALL record this in its consuming system.

Control0..1
TypeReference(Patient|RelatedPerson|Practitioner|PractitionerRole)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summarytrue
Alternate NamesSource, Informant
Comments

The recorder takes responsibility for the content, but can reference the source from where they got it.

Special remarks for KMEHR users: As the FHIR asserter is not the party taking responsibility, this is not equal to the 'author' concept in KMEHR.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
33. AllergyIntolerance.lastOccurrence
Definition

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

Control0..1
TypedateTime
Summaryfalse
Comments

This date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
34. AllergyIntolerance.note
Definition

Additional narrative about the propensity for the Adverse Reaction, not captured in other fields.

Control0..*
TypeAnnotation
Must Supporttrue
Summaryfalse
Comments

For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
35. AllergyIntolerance.reaction
Definition

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

When available, a provider SHOULD include it in the istance. When given, a consumer SHALL record this in its consuming system.

Control0..*
TypeBackboneElement
Must Supporttrue
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
36. AllergyIntolerance.reaction.id
Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Control0..1
Typestring
XML RepresentationIn the XML format, this property is represented as an attribute.
Summaryfalse
37. AllergyIntolerance.reaction.extension
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.

Control0..*
TypeExtension
Summaryfalse
Alternate Namesextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
38. AllergyIntolerance.reaction.modifierExtension
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.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Control0..*
TypeExtension
Is Modifiertrue
Summarytrue
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.

Alternate Namesextensions, user content, modifiers
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (: extension.exists() != value.exists())
39. AllergyIntolerance.reaction.substance
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.

Control0..1
BindingFor example codes, see SubstanceCode Codes defining the type of the substance (including pharmaceutical products)
TypeCodeableConcept
Summaryfalse
Comments

Coding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, "penicillins"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, "amoxycillin"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
40. AllergyIntolerance.reaction.manifestation
Definition

Clinical symptoms and/or signs that are observed or associated with the adverse reaction event.

When available, a provider SHOULD include it. When given, a consumer SHALL record this in its consuming system. If needed codes can be used outside the given valueset, SNOMED-CT is preferred.

Control1..1
BindingThe codes SHALL be taken from BeRiskManifestation; other codes may be used where these codes are not suitable
TypeCodeableConcept
Must Supporttrue
Summaryfalse
Alternate NamesSymptoms, Signs
Comments

Manifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
41. AllergyIntolerance.reaction.description
Definition

Text description about the reaction as a whole, including details of the manifestation if required.

Control0..1
Typestring
Summaryfalse
Alternate NamesNarrative, Text
Comments

Use the description to provide any details of a particular event of the occurred reaction such as circumstances, reaction specifics, what happened before/after. Information, related to the event, but not describing a particular care should be captured in the comment field. For example: at the age of four, the patient was given penicillin for strep throat and subsequently developed severe hives.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
42. AllergyIntolerance.reaction.onset
Definition

Record of the date and/or time of the onset of the Reaction.

Control0..1
TypedateTime
Must Supporttrue
Summaryfalse
InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
43. AllergyIntolerance.reaction.severity
Definition

Clinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations.

Control0..1
BindingThe codes SHALL be taken from AllergyIntoleranceSeverity Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations
Typecode
Summaryfalse
Comments

It is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
44. AllergyIntolerance.reaction.exposureRoute
Definition

Identification of the route by which the subject was exposed to the substance. If needed codes can be used outside the given valueset, SNOMED-CT is preferred.

Control0..1
BindingThe codes SHALL be taken from BeExposureRoute; other codes may be used where these codes are not suitable
TypeCodeableConcept
Summaryfalse
Comments

Coding of the route of exposure with a terminology should be used wherever possible.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
45. AllergyIntolerance.reaction.note
Definition

Additional text about the adverse reaction event not captured in other fields.

A note on this level SHOULD be avoided when not absolutely necessary. Preferably use the .note one level higher.

Control0..*
TypeAnnotation
Summaryfalse
Comments

Use this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased.

InvariantsDefined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))