description: Base StructureDefinition for AllergyIntolerance Resource package_name: hl7.fhir.r2b.core derivation: specialization name: AllergyIntolerance type: null elements: patient: isModifier: false short: Who the sensitivity is for index: 6 type: Reference mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.patient} isSummary: true onset: isModifier: false short: Date(/time) when manifestations showed type: dateTime mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.onset} isSummary: true index: 10 category: isModifier: false short: food | medication | environment | other - Category of Substance index: 3 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. type: code mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.category} isSummary: true criticality: isModifier: false short: low | high | unable-to-assess index: 4 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 mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.criticality} isSummary: true lastOccurence: isModifier: false short: Date(/time) of last known occurrence of a reaction index: 11 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 mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.lastOccurence} isSummary: true type: isModifier: false short: allergy | intolerance - Underlying mechanism (if known) index: 2 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 mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.type} isSummary: true note: isModifier: false short: Additional text not captured in other fields index: 12 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 mustSupport: false array: true maxLength: 0 base: {max: '*', min: 0, path: AllergyIntolerance.note} isSummary: false substance: isModifier: false short: Substance, (or class) considered to be responsible for risk index: 5 comments: It is strongly recommended that the substance be coded with 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 about a substance can be specified in the text. type: CodeableConcept mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.substance} isSummary: true recordedDate: isModifier: false short: When recorded type: dateTime mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.recordedDate} isSummary: true index: 7 reporter: isModifier: false short: Source of the information about the allergy index: 9 comments: The recorder takes repsonsibility for the content, but can reference the source from where they got it. type: Reference mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.reporter} isSummary: true status: isModifier: true short: active | unconfirmed | confirmed | inactive | resolved | refuted | entered-in-error index: 1 comments: Decision support would typically raise alerts for 'Unconfirmed', 'Confirmed', and 'Resolved' and ignore a 'Refuted' reaction. In particular, 'Refuted' may be useful for reconciliation of the Adverse Reaction List. Some implementations may choose to make this field mandatory. type: code mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.status} isSummary: true recorder: isModifier: false short: Who recorded the sensitivity type: Reference mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.recorder} isSummary: true index: 8 identifier: isModifier: false short: External ids for this item index: 0 type: Identifier mustSupport: false array: true maxLength: 0 base: {max: '*', min: 0, path: AllergyIntolerance.identifier} isSummary: true reaction: isModifier: false short: Adverse Reaction Events linked to exposure to substance index: 13 type: BackboneElement mustSupport: false array: true elements: substance: isModifier: false short: Specific substance considered to be responsible for event index: 14 comments: Coding of the specific substance with a terminology capable of triggering decision support should be used wherever possible. The substance field allows for the use of a specific substance or a group or class of substances, for example "Penicillins". The specific substance field could be used for Amoxycillin. Duplication is acceptable when a specific substance has been recorded in the 'substance' field. type: CodeableConcept mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.reaction.substance} isSummary: true certainty: isModifier: false short: unlikely | likely | confirmed - clinical certainty about the specific substance type: code mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.reaction.certainty} isSummary: true index: 15 manifestation: min: 1 isModifier: false short: Clinical symptoms/signs associated with the Event index: 16 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 mustSupport: false array: true maxLength: 0 base: {max: '*', min: 0, path: AllergyIntolerance.reaction.manifestation} isSummary: true description: isModifier: false short: Description of the event as a whole index: 17 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 mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.reaction.description} isSummary: false onset: isModifier: false short: Date(/time) when manifestations showed type: dateTime mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.reaction.onset} isSummary: true index: 18 severity: isModifier: false short: mild | moderate | severe (of event as a whole) index: 19 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 mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.reaction.severity} isSummary: true exposureRoute: isModifier: false short: How the subject was exposed to the substance index: 20 comments: Coding of the route of exposure with a terminology should be used wherever possible. type: CodeableConcept mustSupport: false maxLength: 0 base: {max: '1', min: 0, path: AllergyIntolerance.reaction.exposureRoute} isSummary: true note: isModifier: false short: Text about event not captured in other fields index: 21 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 mustSupport: false array: true maxLength: 0 base: {max: '*', min: 0, path: AllergyIntolerance.reaction.note} isSummary: false maxLength: 0 base: {max: '*', min: 0, path: AllergyIntolerance.reaction} required: [manifestation] isSummary: false package_version: 1.4.0 class: resource kind: resource url: http://hl7.org/fhir/StructureDefinition/AllergyIntolerance base: http://hl7.org/fhir/StructureDefinition/DomainResource version: null required: [substance, patient]