description: Base StructureDefinition for AllergyIntolerance Resource package_name: hl7.fhir.core derivation: specialization name: AllergyIntolerance type: AllergyIntolerance elements: patient: short: Who the sensitivity is for refers: ['http://hl7.org/fhir/StructureDefinition/Patient'] type: Reference isSummary: true index: 7 onset: short: When allergy or intolerance was identified choices: [onsetDateTime, onsetAge, onsetPeriod, onsetRange, onsetString] index: 9 category: {short: food | medication | biologic | environment, 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](search.html) for more information on how to search category with a :missing modifier to get allergies that don''t have a category.', type: code, array: true, isSummary: true, index: 4} criticality: {short: low | high | unable-to-assess, 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).', type: code, isSummary: true, index: 5} clinicalStatus: {isModifier: true, short: active | inactive | resolved, type: code, isSummary: true, index: 1} onsetRange: {short: When allergy or intolerance was identified, type: Range, choiceOf: onset, index: 13} onsetAge: {short: When allergy or intolerance was identified, type: Age, choiceOf: onset, index: 11} onsetPeriod: {short: When allergy or intolerance was identified, type: Period, choiceOf: onset, index: 12} type: {short: allergy | intolerance - Underlying mechanism (if known), 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 may 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 may 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.', type: code, isSummary: true, index: 3} asserter: short: Source of the information about the allergy refers: ['http://hl7.org/fhir/StructureDefinition/Patient', 'http://hl7.org/fhir/StructureDefinition/Practitioner', 'http://hl7.org/fhir/StructureDefinition/RelatedPerson'] comments: The recorder takes repsonsibility for the content, but can reference the source from where they got it. type: Reference isSummary: true index: 17 note: {short: Additional text not captured in other fields, 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.', type: Annotation, array: true, index: 19} assertedDate: {type: dateTime, short: Date record was believed accurate, index: 15} onsetString: {short: When allergy or intolerance was identified, type: string, choiceOf: onset, index: 14} recorder: short: Who recorded the sensitivity refers: ['http://hl7.org/fhir/StructureDefinition/Patient', 'http://hl7.org/fhir/StructureDefinition/Practitioner'] type: Reference index: 16 code: {short: Allergy or intolerance code, comments: "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, UNI, ATC and CPT. Plain text should only be used if there is no appropriate terminology available. Additional details can be specified in the text.\r\rWhen 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.\r\rThe '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.", type: CodeableConcept, isSummary: true, index: 6} identifier: {short: External ids for this item, type: Identifier, array: true, isSummary: true, index: 0} onsetDateTime: {short: When allergy or intolerance was identified, type: dateTime, choiceOf: onset, index: 10} lastOccurrence: {short: Date(/time) of last known occurrence of a reaction, 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.', type: dateTime, index: 18} verificationStatus: {isModifier: true, short: unconfirmed | confirmed | refuted | entered-in-error, comments: 'Decision support would typically raise alerts for ''confirmed'' and ''unconfirmed'' and ignore a ''refuted'' reaction. In particular, ''refuted'' may be useful for reconciliation of the Adverse Reaction List.', type: code, isSummary: true, index: 2} reaction: type: BackboneElement short: Adverse Reaction Events linked to exposure to substance array: true index: 20 elements: substance: {short: Specific substance or pharmaceutical product considered to be responsible for event, 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 identifed 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''.', type: CodeableConcept, index: 21} certainty: {short: unlikely | likely | confirmed | unknown, comments: 'When certainty is missing, it means no information exists (although it could be in narrative). By contrast, the unknown code is used when there is an explicit assertion that certainty is not known, such as when a patient eats a meal and it is unknown which food caused the reaction.', type: code, index: 22} manifestation: {min: 1, short: Clinical symptoms/signs associated with the Event, 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.', type: CodeableConcept, array: true, index: 23} description: {short: Description of the event as a whole, 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.', type: string, index: 24} onset: {type: dateTime, short: Date(/time) when manifestations showed, index: 25} severity: {short: mild | moderate | severe (of event as a whole), comments: It is acknowledged that this assessment is very subjective. There may be some some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions., type: code, index: 26} exposureRoute: {short: How the subject was exposed to the substance, comments: Coding of the route of exposure with a terminology should be used wherever possible., type: CodeableConcept, index: 27} note: {short: Text about event not captured in other fields, 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.', type: Annotation, array: true, index: 28} required: [manifestation] package_version: 1.8.0 class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/AllergyIntolerance base: http://hl7.org/fhir/StructureDefinition/DomainResource version: null required: [verificationStatus, patient]