Australian Digital Health Agency FHIR Implementation Guide
1.2.0-ci-build - draft Australia flag

Australian Digital Health Agency FHIR Implementation Guide, published by Australian Digital Health Agency. This guide is not an authorized publication; it is the continuous build for version 1.2.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/AuDigitalHealth/ci-fhir-r4/ and changes regularly. See the Directory of published versions

Resource Profile: ADHAAllergyIntoleranceCore - Detailed Descriptions

Draft as of 2024-09-12

Definitions for the dh-allergyintolerance-core-1 resource profile.

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

0. AllergyIntolerance
Invariantsinv-dh-ait-01: If present, an asserter shall at least have a reference, an identifier or a display (asserter.exists() implies asserter.all($this.reference.exists() or $this.identifier.exists() or $this.display.exists()))
2. AllergyIntolerance.type
Must Supporttrue
4. AllergyIntolerance.category
Must Supporttrue
6. AllergyIntolerance.criticality
Must Supporttrue
8. AllergyIntolerance.patient
TypeReference(AU Core Patient)
10. AllergyIntolerance.encounter
TypeReference(AU Core Encounter)
Invariantsinv-dh-ait-02: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
12. AllergyIntolerance.recorder
Control1..?
TypeReference(AU Core Patient, AU Base Related Person, AU Core PractitionerRole)
Invariantsinv-dh-ait-03: At least reference or display or a valid identifier shall be present (reference.exists() or display.exists() or identifier.where(system.count() + value.count() >1).exists())
14. AllergyIntolerance.asserter
TypeReference(AU Core Patient, AU Base Related Person, AU Core PractitionerRole)
16. AllergyIntolerance.reaction
18. AllergyIntolerance.reaction.substance
Must Supporttrue

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

0. AllergyIntolerance
Definition

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

ShortAn allergy or intolerance statement in an Australian healthcare contextAllergy or Intolerance (generally: Risk of adverse reaction to a substance)
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.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesAllergy, Intolerance, Adverse Reaction
Invariantsait-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())
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())
inv-dh-ait-01: If present, an asserter shall at least have a reference, an identifier or a display (asserter.exists() implies asserter.all($this.reference.exists() or $this.identifier.exists() or $this.display.exists()))
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())
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.

ShortA set of rules under which this content was created
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.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. 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).

ShortExtensions that cannot be ignored
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.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
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
Invariantsele-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.clinicalStatus
Definition

The clinical status of the allergy or intolerance.

Shortactive | inactive | resolved
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.

Control0..1
This element is affected by the following invariants: ait-1, ait-2
BindingThe codes SHALL be taken from AllergyIntoleranceClinicalStatusCodeshttp://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1
(required to http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1)

The clinical status of the allergy or intolerance.

TypeCodeableConcept
Is Modifiertrue because This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as no longer active.
Must Supporttrue
Obligations
    ObligationsActor
    SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
    SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. AllergyIntolerance.verificationStatus
    Definition

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

    Shortunconfirmed | confirmed | refuted | entered-in-error
    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.

    Control0..1
    This element is affected by the following invariants: ait-1, ait-2
    BindingThe codes SHALL be taken from AllergyIntoleranceVerificationStatusCodeshttp://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1
    (required to http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1)

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

    TypeCodeableConcept
    Is Modifiertrue because This element is labeled as a modifier because the status contains the codes refuted and entered-in-error that mark the AllergyIntolerance as not currently valid.
    Must Supporttrue
    Obligations
      ObligationsActor
      SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
      SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. AllergyIntolerance.type
      Definition

      Identification of the underlying physiological mechanism for the reaction risk.

      Shortallergy | 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 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.

      Control0..1
      BindingThe codes SHALL be taken from AllergyIntoleranceTypehttp://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1
      (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1)

      Identification of the underlying physiological mechanism for a Reaction Risk.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Alternate NamesCategory, Class
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. AllergyIntolerance.category
      Definition

      Category of the identified substance.

      Shortfood | medication | environment | biologic
      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.

      Control0..*
      BindingThe codes SHALL be taken from AllergyIntoleranceCategoryhttp://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1
      (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1)

      Category of an identified substance associated with allergies or intolerances.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Alternate NamesCategory, Type, Reaction Type, Class
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      14. AllergyIntolerance.criticality
      Definition

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

      Shortlow | 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). 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.

      Control0..1
      BindingThe codes SHALL be taken from AllergyIntoleranceCriticalityhttp://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1
      (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1)

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

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Alternate NamesSeverity, Seriousness, Contra-indication, Risk
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. AllergyIntolerance.code
      Definition

      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.

      ShortCode that identifies the allergy or intolerance
      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, 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.

      Control10..1
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see Indicator of Hypersensitivity or Intolerance to Substance .http://hl7.org/fhir/ValueSet/allergyintolerance-code
      (extensible to https://healthterminologies.gov.au/fhir/ValueSet/indicator-hypersensitivity-intolerance-to-substance-2)
      Additional BindingsPurposeDocumentation
      Adverse Reaction Substances and Negated Findings .candidate

      The Adverse Reaction Substances and Negated Findings value set comprises terms used to identify a predisposition to adverse reactions to substances, as well as negated findings.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Obligations
        ObligationsActor
        SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
        SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
        Summarytrue
        Alternate NamesCode
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. AllergyIntolerance.patient
        Definition

        The patient who has the allergy or intolerance.

        ShortWho the sensitivity is for
        Control1..1
        TypeReference(AU Core Patient, Patient)
        Is Modifierfalse
        Must Supporttrue
        Obligations
          ObligationsActor
          SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
          SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
          Summarytrue
          Alternate NamesPatient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          20. AllergyIntolerance.encounter
          Definition

          The encounter when the allergy or intolerance was asserted.

          ShortEncounter when the allergy or intolerance was asserted
          Control0..1
          TypeReference(AU Core Encounter, Encounter)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          inv-dh-ait-02: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
          22. AllergyIntolerance.onset[x]
          Definition

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

          ShortWhen allergy or intolerance was identified
          Control0..1
          TypeChoice of: dateTime, Age, Period, Range, string
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          Obligations
            ObligationsActor
            SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
            SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. AllergyIntolerance.recorder
            Definition

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

            ShortWho recorded the sensitivity
            Control10..1
            TypeReference(AU Core Patient, AU Base Related Person, AU Core PractitionerRole, Practitioner, PractitionerRole, Patient, RelatedPerson)
            Is Modifierfalse
            Summaryfalse
            Alternate NamesAuthor
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            inv-dh-ait-03: At least reference or display or a valid identifier shall be present (reference.exists() or display.exists() or identifier.where(system.count() + value.count() >1).exists())
            26. AllergyIntolerance.asserter
            Definition

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

            ShortSource of the information about the allergy
            Comments

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

            Control0..1
            This element is affected by the following invariants: inv-dh-ait-01
            TypeReference(AU Core Patient, AU Base Related Person, AU Core PractitionerRole, Patient, RelatedPerson, Practitioner, PractitionerRole)
            Is Modifierfalse
            Summarytrue
            Alternate NamesSource, Informant
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. AllergyIntolerance.reaction
            Definition

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

            ShortAdverse Reaction Events linked to exposure to substance
            Control0..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supporttrue
            Obligations
              ObligationsActor
              SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
              SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. 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).

              ShortExtensions that cannot be ignored even if unrecognized
              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.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              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
              Invariantsele-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())
              32. 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.

              ShortSpecific 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 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'.

              Control0..1
              BindingThe codes SHOULD be taken from For example codes, see Adverse Reaction Agent .http://hl7.org/fhir/ValueSet/substance-code
              (preferred to https://healthterminologies.gov.au/fhir/ValueSet/adverse-reaction-agent-1)
              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. AllergyIntolerance.reaction.manifestation
              Definition

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

              ShortClinical 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.

              Control1..*
              BindingThe codes SHOULD be taken from For example codes, see Clinical Finding .http://hl7.org/fhir/ValueSet/clinical-findings
              (preferred to https://healthterminologies.gov.au/fhir/ValueSet/clinical-finding-1)
              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Obligations
                ObligationsActor
                SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                Summaryfalse
                Alternate NamesSymptoms, Signs
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                36. AllergyIntolerance.reaction.severity
                Definition

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

                Shortmild | moderate | severe (of event as a whole)
                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.

                Control0..1
                BindingThe codes SHALL be taken from AllergyIntoleranceSeverityhttp://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1
                (required to http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1)

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

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Obligations
                  ObligationsActor
                  SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                  SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                  Summaryfalse
                  Invariantsele-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

                  0. AllergyIntolerance
                  Definition

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

                  ShortAn allergy or intolerance statement in an Australian healthcare context
                  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.

                  Control0..*
                  Is Modifierfalse
                  Summaryfalse
                  Alternate NamesAllergy, Intolerance, Adverse Reaction
                  Invariantsait-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())
                  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())
                  inv-dh-ait-01: If present, an asserter shall at least have a reference, an identifier or a display (asserter.exists() implies asserter.all($this.reference.exists() or $this.identifier.exists() or $this.display.exists()))
                  2. AllergyIntolerance.id
                  Definition

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

                  ShortLogical id of this artifact
                  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.

                  Control0..1
                  Typeid
                  Is Modifierfalse
                  Summarytrue
                  4. 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.

                  ShortMetadata about the resource
                  Control0..1
                  TypeMeta
                  Is Modifierfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  6. 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.

                  ShortA set of rules under which this content was created
                  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.

                  Control0..1
                  Typeuri
                  Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  8. AllergyIntolerance.language
                  Definition

                  The base language in which the resource is written.

                  ShortLanguage of the resource content
                  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).

                  Control0..1
                  BindingThe codes SHOULD be taken from CommonLanguages
                  (preferred to http://hl7.org/fhir/ValueSet/languages)

                  A human language.

                  Additional BindingsPurpose
                  AllLanguagesMax Binding
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  10. 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.

                  ShortText summary of the resource, for human interpretation
                  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.

                  Control0..1
                  TypeNarrative
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesnarrative, html, xhtml, display
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  12. 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.

                  ShortContained, inline 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.

                  Control0..*
                  TypeResource
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesinline resources, anonymous resources, contained resources
                  14. AllergyIntolerance.extension
                  Definition

                  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.

                  ShortAdditional content defined by implementations
                  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.

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-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())
                  16. 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).

                  ShortExtensions that cannot be ignored
                  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.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                  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
                  Invariantsele-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())
                  18. 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.

                  ShortExternal ids for this item
                  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.

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

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

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  20. AllergyIntolerance.clinicalStatus
                  Definition

                  The clinical status of the allergy or intolerance.

                  Shortactive | inactive | resolved
                  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.

                  Control0..1
                  This element is affected by the following invariants: ait-1, ait-2
                  BindingThe codes SHALL be taken from AllergyIntoleranceClinicalStatusCodes
                  (required to http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1)

                  The clinical status of the allergy or intolerance.

                  TypeCodeableConcept
                  Is Modifiertrue because This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as no longer active.
                  Must Supporttrue
                  Obligations
                    ObligationsActor
                    SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                    SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                    Summarytrue
                    Invariantsele-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).

                    Shortunconfirmed | confirmed | refuted | entered-in-error
                    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.

                    Control0..1
                    This element is affected by the following invariants: ait-1, ait-2
                    BindingThe codes SHALL be taken from AllergyIntoleranceVerificationStatusCodes
                    (required to http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1)

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

                    TypeCodeableConcept
                    Is Modifiertrue because This element is labeled as a modifier because the status contains the codes refuted and entered-in-error that mark the AllergyIntolerance as not currently valid.
                    Must Supporttrue
                    Obligations
                      ObligationsActor
                      SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                      SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      24. AllergyIntolerance.type
                      Definition

                      Identification of the underlying physiological mechanism for the reaction risk.

                      Shortallergy | 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 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.

                      Control0..1
                      BindingThe codes SHALL be taken from AllergyIntoleranceType
                      (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1)

                      Identification of the underlying physiological mechanism for a Reaction Risk.

                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Alternate NamesCategory, Class
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      26. AllergyIntolerance.category
                      Definition

                      Category of the identified substance.

                      Shortfood | medication | environment | biologic
                      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.

                      Control0..*
                      BindingThe codes SHALL be taken from AllergyIntoleranceCategory
                      (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1)

                      Category of an identified substance associated with allergies or intolerances.

                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Alternate NamesCategory, Type, Reaction Type, Class
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      28. AllergyIntolerance.criticality
                      Definition

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

                      Shortlow | 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). 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.

                      Control0..1
                      BindingThe codes SHALL be taken from AllergyIntoleranceCriticality
                      (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1)

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

                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Summarytrue
                      Alternate NamesSeverity, Seriousness, Contra-indication, Risk
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      30. AllergyIntolerance.code
                      Definition

                      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.

                      ShortCode that identifies the allergy or intolerance
                      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, 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.

                      Control1..1
                      BindingUnless not suitable, these codes SHALL be taken from Indicator of Hypersensitivity or Intolerance to Substance .
                      (extensible to https://healthterminologies.gov.au/fhir/ValueSet/indicator-hypersensitivity-intolerance-to-substance-2)
                      Additional BindingsPurposeDocumentation
                      Adverse Reaction Substances and Negated Findings .candidate

                      The Adverse Reaction Substances and Negated Findings value set comprises terms used to identify a predisposition to adverse reactions to substances, as well as negated findings.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supporttrue
                      Obligations
                        ObligationsActor
                        SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                        SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                        Summarytrue
                        Alternate NamesCode
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        32. AllergyIntolerance.patient
                        Definition

                        The patient who has the allergy or intolerance.

                        ShortWho the sensitivity is for
                        Control1..1
                        TypeReference(AU Core Patient)
                        Is Modifierfalse
                        Must Supporttrue
                        Obligations
                          ObligationsActor
                          SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                          SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                          Summarytrue
                          Alternate NamesPatient
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          34. AllergyIntolerance.encounter
                          Definition

                          The encounter when the allergy or intolerance was asserted.

                          ShortEncounter when the allergy or intolerance was asserted
                          Control0..1
                          TypeReference(AU Core Encounter)
                          Is Modifierfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          inv-dh-ait-02: At least reference or a valid identifier shall be present (reference.exists() or identifier.where(system.count() + value.count() >1).exists())
                          36. AllergyIntolerance.onset[x]
                          Definition

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

                          ShortWhen allergy or intolerance was identified
                          Control0..1
                          TypeChoice of: dateTime, Age, Period, Range
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Must Supporttrue
                          Must Support TypesNo must-support rules about the choice of types/profiles
                          Obligations
                            ObligationsActor
                            SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                            SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            38. AllergyIntolerance.recordedDate
                            Definition

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

                            ShortDate first version of the resource instance was recorded
                            Control0..1
                            TypedateTime
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            40. AllergyIntolerance.recorder
                            Definition

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

                            ShortWho recorded the sensitivity
                            Control1..1
                            TypeReference(AU Core Patient, AU Base Related Person, AU Core PractitionerRole)
                            Is Modifierfalse
                            Summaryfalse
                            Alternate NamesAuthor
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            inv-dh-ait-03: At least reference or display or a valid identifier shall be present (reference.exists() or display.exists() or identifier.where(system.count() + value.count() >1).exists())
                            42. AllergyIntolerance.asserter
                            Definition

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

                            ShortSource of the information about the allergy
                            Comments

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

                            Control0..1
                            This element is affected by the following invariants: inv-dh-ait-01
                            TypeReference(AU Core Patient, AU Base Related Person, AU Core PractitionerRole)
                            Is Modifierfalse
                            Summarytrue
                            Alternate NamesSource, Informant
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            44. AllergyIntolerance.lastOccurrence
                            Definition

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

                            ShortDate(/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.

                            Control0..1
                            TypedateTime
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            46. AllergyIntolerance.note
                            Definition

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

                            ShortAdditional 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.

                            Control0..*
                            TypeAnnotation
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            48. AllergyIntolerance.reaction
                            Definition

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

                            ShortAdverse Reaction Events linked to exposure to substance
                            Control0..*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supporttrue
                            Obligations
                              ObligationsActor
                              SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                              SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              50. 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.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              Typestring
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              52. 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.

                              ShortAdditional content defined by implementations
                              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.

                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Alternate Namesextensions, user content
                              Invariantsele-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())
                              54. 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).

                              ShortExtensions that cannot be ignored even if unrecognized
                              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.

                              Control0..*
                              TypeExtension
                              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                              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
                              Invariantsele-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())
                              56. 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.

                              ShortSpecific 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 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'.

                              Control0..1
                              BindingThe codes SHOULD be taken from Adverse Reaction Agent .
                              (preferred to https://healthterminologies.gov.au/fhir/ValueSet/adverse-reaction-agent-1)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              58. AllergyIntolerance.reaction.manifestation
                              Definition

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

                              ShortClinical 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.

                              Control1..*
                              BindingThe codes SHOULD be taken from Clinical Finding .
                              (preferred to https://healthterminologies.gov.au/fhir/ValueSet/clinical-finding-1)
                              TypeCodeableConcept
                              Is Modifierfalse
                              Must Supporttrue
                              Obligations
                                ObligationsActor
                                SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                                SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                                Summaryfalse
                                Alternate NamesSymptoms, Signs
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                60. AllergyIntolerance.reaction.description
                                Definition

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

                                ShortDescription 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.

                                Control0..1
                                Typestring
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Alternate NamesNarrative, Text
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                62. AllergyIntolerance.reaction.onset
                                Definition

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

                                ShortDate(/time) when manifestations showed
                                Control0..1
                                TypedateTime
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                64. AllergyIntolerance.reaction.severity
                                Definition

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

                                Shortmild | moderate | severe (of event as a whole)
                                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.

                                Control0..1
                                BindingThe codes SHALL be taken from AllergyIntoleranceSeverity
                                (required to http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1)

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

                                Typecode
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Must Supporttrue
                                Obligations
                                  ObligationsActor
                                  SHALL:populate-if-knownhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-responder
                                  SHALL:no-errorhttp://hl7.org.au/fhir/core/ActorDefinition/au-core-actor-requester
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  66. AllergyIntolerance.reaction.exposureRoute
                                  Definition

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

                                  ShortHow the subject was exposed to the substance
                                  Comments

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

                                  Control0..1
                                  BindingThe codes SHOULD be taken from Route of Administration .
                                  (preferred to https://healthterminologies.gov.au/fhir/ValueSet/route-of-administration-1)
                                  TypeCodeableConcept
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  68. AllergyIntolerance.reaction.note
                                  Definition

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

                                  ShortText 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.

                                  Control0..*
                                  TypeAnnotation
                                  Is Modifierfalse
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))