CA Baseline AllergyIntolerance Profile

This profile sets minimum expectations for the AllergyIntolerance resource to record, search and fetch allergies/adverse reactions associated with a patient. It documents the relevant allergies or intolerances (conditions) for a patient, describing the kind of reaction, agent(s) that cause it, criticality and the certainty of the allergy/adverse reaction.

This profile defines localization concepts for use in the Canadian context.

Mandatory Data Elements

All elements or attributes within the FHIR specification have cardinality as part of their definition - a minimum number of required appearances and a maximum number of allowable appearances.

Most elements in the FHIR specification have a minimum cardinality of 0, so most elements are not required and subsequently they may be missing from a resource when it is exchanged between systems.

Required elements in the AllergyIntolerance profile:

• subject who has the allergy or intolerance (AllergyIntolerance.patient)

Must Support Data Elements

Some elements are marked as Must Support. This means that implementations generating, receiving, or otherwise using resources with Must Support elements SHALL provide support for those elements in some meaningful way (see Must Support definition).

The following elements are marked as Must Support in the AllergyIntolerance profile:

Must Support elements:

• code of the allergy or intolerance (AllergyIntolerance.code)
• reference to a subject (AllergyIntolerance.patient)
• manifestation of clinical symptoms (AllergyIntolerance.reaction.manifestation)

Usage Note

The AllergyIntolerance resource instance use could be clinical decision support applications to generate/display warnings about potentially harmful medications; any intolerance to other agents (e.g. intolerance to soaps, dressings, latex, etc.) more relevant for at the bedside care.

This profile utilizes and recommends some value sets that exist on the Infoway Terminology Gateway and can be assessed by API. Implementors using and/or re-profiling from this profile should be aware that the IGPublisher can not directly resolve the canonical url to value sets that exist on the Infoway Terminology Gateway due to technical limitations and will produce warnings in the qa.txt file when this occurs. These particular warnings have been suppressed in this specification and will need to be suppressed by other IGuide authors looking to leverage this particular service until the limitations are resolved.

Profile specific implementation guidance

History of Allergy or Intolerance

If the patient has been asked and has indicated a history of allergy or intolerance then this information is represented by:

• AllergyIntolerance.code - an appropriate SNOMED CT code

• AllergyIntolerance.verificationStatus element SHALL be one of the following: confirmed

  refuted

  entered-in-error

If a patient asserts a history of allergy or intolerance then the following elements SHOULD be populated:

• AllergyIntolerance.criticality
• AllergyIntolerance.severity
• AllergyIntolerance.type

No Allergy

If a patient has been asked and has indicated no history of allergies or intolerance then this is represented by:

• AllergyIntolerance.code = "716186003" No known allergy (situation) SNOMED CT code

• AllergyIntolerance.verificationStatus element SHALL be one of the following: confirmed

  refuted

  entered-in-error

Not Asked

If the patient has NOT been asked or it is NOT possible to obtain information about any history of allergy or intolerance then this situation is represented with NullFlavor codes:

• AllergyIntolerance.code - NullFalvor code, e.g., "NASK" (Not asked).

If NullFlavor is used then the following elements SHOULD NOT be populated:

• AllergyIntolerance.clinicalStatus
• AllergyIntolerance.verificationStatus
• AllergyIntolerance.type
• AllergyIntolerance.category
• AllergyIntolerance.criticality

and other allergy related elements.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from AllergyIntolerance

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	AllergyIntolerance	AllergyIntolerance Profile ca-baseline-allergy: AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept ca-baseline-allergy-notasked: if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present ca-baseline-allergy-noallergy: if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error
identifier		0..*	Identifier	External ids for this item
clinicalStatus	?!	0..1	CodeableConcept	active | inactive | resolved
verificationStatus	?!	0..1	CodeableConcept	unconfirmed | confirmed | refuted | entered-in-error
category		0..*	code	food | medication | environment | biologic
code	S	0..1	CodeableConcept	Code that identifies the allergy or intolerance
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NotAsked		0..1	Coding	Code for NOT asked or NOT possible to obtain information about allergy or intolerance Binding: https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor (preferred): Negation/exclusion codes for reporting no known allergies or not available data.
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/v3/NullFlavor
code		1..1	code	Symbol in syntax defined by the system
coding:NoAllergy		0..1	Coding	Code when a patient has been asked and has indicated no history of allergies or intolerance
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 716186003
coding:@default		0..1	Coding	Code defined by a terminology system Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition.
patient	S	1..1	Reference(Patient Profile)	Who the sensitivity is for
encounter		0..1	Reference(Encounter Profile)	Encounter when the allergy or intolerance was asserted
Slices for onsetDateTime				Content/Rules for all slices
onsetDateTime:onsetDateTime		0..1	dateTime	When allergy or intolerance was identified
recorder		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile)	Who recorded the sensitivity
asserter		0..1	Reference(Patient Profile | Practitioner Profile (General) | PractitionerRole Profile (General))	Source of the information about the allergy
reaction
substance		0..1	CodeableConcept	Specific substance or pharmaceutical product considered to be responsible for event
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NonDrugAllergen		0..*	Coding	Code for the specific non-drug allergen Binding: https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode (preferred): Represents the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction.
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
coding:CCDD		0..*	Coding	Medicinal products for prescribing Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): Represents subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada.
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
code		1..1	code	Symbol in syntax defined by the system
coding:@default		0..*	Coding	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event
exposureRoute		0..1	CodeableConcept	How the subject was exposed to the substance Binding: https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration (preferred): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
AllergyIntolerance.code.coding:NotAsked	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor
AllergyIntolerance.code.coding:@default	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.reaction.substance.coding:NonDrugAllergen	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode
AllergyIntolerance.reaction.substance.coding:CCDD	preferred	https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
AllergyIntolerance.reaction.substance.coding:@default	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.exposureRoute	preferred	https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-allergy	error	AllergyIntolerance	AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies verificationStatus.exists()
ca-baseline-allergy-noallergy	error	AllergyIntolerance	if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error : code.coding.where(system = 'http://snomed.info/sct' and code = '716186003').exists() and verificationStatus.coding.where(code = 'unconfirmed').empty()
ca-baseline-allergy-notasked	error	AllergyIntolerance	if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies type.exists().not() and category.exists().not() and criticality.exists().not()

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	AllergyIntolerance	AllergyIntolerance Profile ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error ca-baseline-allergy: AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept ca-baseline-allergy-notasked: if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present ca-baseline-allergy-noallergy: if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External ids for this item
clinicalStatus	?!ΣC	0..1	CodeableConcept	active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required): The clinical status of the allergy or intolerance.
verificationStatus	?!ΣC	0..1	CodeableConcept	unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required): Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
category	Σ	0..*	code	food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
code	SΣ	0..1	CodeableConcept	Code that identifies the allergy or intolerance Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NotAsked	Σ	0..1	Coding	Code for NOT asked or NOT possible to obtain information about allergy or intolerance Binding: https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor (preferred): Negation/exclusion codes for reporting no known allergies or not available data.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/v3/NullFlavor
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:NoAllergy	Σ	0..1	Coding	Code when a patient has been asked and has indicated no history of allergies or intolerance
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 716186003
coding:@default	Σ	0..1	Coding	Code defined by a terminology system Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition.
patient	SΣ	1..1	Reference(Patient Profile)	Who the sensitivity is for
encounter		0..1	Reference(Encounter Profile)	Encounter when the allergy or intolerance was asserted
Slices for onset[x]		0..1		When allergy or intolerance was identified Slice: Unordered, Open by type:$this
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
onset[x]:onsetDateTime		0..1	dateTime	When allergy or intolerance was identified
recorder		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile)	Who recorded the sensitivity
asserter	Σ	0..1	Reference(Patient Profile | Practitioner Profile (General) | PractitionerRole Profile (General))	Source of the information about the allergy
reaction		0..*	BackboneElement	Adverse Reaction Events linked to exposure to substance
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
substance		0..1	CodeableConcept	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NonDrugAllergen	Σ	0..*	Coding	Code for the specific non-drug allergen Binding: https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode (preferred): Represents the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction.
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:CCDD	Σ	0..*	Coding	Medicinal products for prescribing Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): Represents subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:@default	Σ	0..*	Coding	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (example): Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
exposureRoute		0..1	CodeableConcept	How the subject was exposed to the substance Binding: https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration (preferred): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
AllergyIntolerance.clinicalStatus	required	AllergyIntoleranceClinicalStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1 from the FHIR Standard
AllergyIntolerance.verificationStatus	required	AllergyIntoleranceVerificationStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1 from the FHIR Standard
AllergyIntolerance.category	required	AllergyIntoleranceCategory http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1 from the FHIR Standard
AllergyIntolerance.code	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.code.coding:NotAsked	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor
AllergyIntolerance.code.coding:@default	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.reaction.substance	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.substance.coding:NonDrugAllergen	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode
AllergyIntolerance.reaction.substance.coding:CCDD	preferred	https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
AllergyIntolerance.reaction.substance.coding:@default	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.manifestation	example	SNOMEDCTClinicalFindings http://hl7.org/fhir/ValueSet/clinical-findings from the FHIR Standard
AllergyIntolerance.reaction.exposureRoute	preferred	https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration

Constraints

Id	Grade	Path(s)	Details	Requirements
ait-1	error	AllergyIntolerance	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	error	AllergyIntolerance	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()
ca-baseline-allergy	error	AllergyIntolerance	AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies verificationStatus.exists()
ca-baseline-allergy-noallergy	error	AllergyIntolerance	if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error : code.coding.where(system = 'http://snomed.info/sct' and code = '716186003').exists() and verificationStatus.coding.where(code = 'unconfirmed').empty()
ca-baseline-allergy-notasked	error	AllergyIntolerance	if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies type.exists().not() and category.exists().not() and criticality.exists().not()
dom-2	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	AllergyIntolerance	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	error	AllergyIntolerance	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	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	AllergyIntolerance	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	AllergyIntolerance	AllergyIntolerance Profile ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error ca-baseline-allergy: AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept ca-baseline-allergy-notasked: if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present ca-baseline-allergy-noallergy: if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External ids for this item
clinicalStatus	?!ΣC	0..1	CodeableConcept	active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required): The clinical status of the allergy or intolerance.
verificationStatus	?!ΣC	0..1	CodeableConcept	unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required): Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
type	Σ	0..1	code	allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category	Σ	0..*	code	food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality	Σ	0..1	code	low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code	SΣ	0..1	CodeableConcept	Code that identifies the allergy or intolerance Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NotAsked	Σ	0..1	Coding	Code for NOT asked or NOT possible to obtain information about allergy or intolerance Binding: https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor (preferred): Negation/exclusion codes for reporting no known allergies or not available data.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/v3/NullFlavor
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NoAllergy	Σ	0..1	Coding	Code when a patient has been asked and has indicated no history of allergies or intolerance
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 716186003
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:@default	Σ	0..1	Coding	Code defined by a terminology system Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition.
text	Σ	0..1	string	Plain text representation of the concept
patient	SΣ	1..1	Reference(Patient Profile)	Who the sensitivity is for
encounter		0..1	Reference(Encounter Profile)	Encounter when the allergy or intolerance was asserted
Slices for onset[x]		0..1		When allergy or intolerance was identified Slice: Unordered, Open by type:$this
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
onset[x]:onsetDateTime		0..1	dateTime	When allergy or intolerance was identified
recordedDate		0..1	dateTime	Date first version of the resource instance was recorded
recorder		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile)	Who recorded the sensitivity
asserter	Σ	0..1	Reference(Patient Profile | Practitioner Profile (General) | PractitionerRole Profile (General))	Source of the information about the allergy
lastOccurrence		0..1	dateTime	Date(/time) of last known occurrence of a reaction
note		0..*	Annotation	Additional text not captured in other fields
reaction		0..*	BackboneElement	Adverse Reaction Events linked to exposure to substance
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
substance		0..1	CodeableConcept	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NonDrugAllergen	Σ	0..*	Coding	Code for the specific non-drug allergen Binding: https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode (preferred): Represents the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:CCDD	Σ	0..*	Coding	Medicinal products for prescribing Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): Represents subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:@default	Σ	0..*	Coding	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
text	Σ	0..1	string	Plain text representation of the concept
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (example): Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
description		0..1	string	Description of the event as a whole
onset		0..1	dateTime	Date(/time) when manifestations showed
severity		0..1	code	mild | moderate | severe (of event as a whole) Binding: AllergyIntoleranceSeverity (required): Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
exposureRoute		0..1	CodeableConcept	How the subject was exposed to the substance Binding: https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration (preferred): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
note		0..*	Annotation	Text about event not captured in other fields
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
AllergyIntolerance.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
AllergyIntolerance.clinicalStatus	required	AllergyIntoleranceClinicalStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1 from the FHIR Standard
AllergyIntolerance.verificationStatus	required	AllergyIntoleranceVerificationStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1 from the FHIR Standard
AllergyIntolerance.type	required	AllergyIntoleranceType http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1 from the FHIR Standard
AllergyIntolerance.category	required	AllergyIntoleranceCategory http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1 from the FHIR Standard
AllergyIntolerance.criticality	required	AllergyIntoleranceCriticality http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1 from the FHIR Standard
AllergyIntolerance.code	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.code.coding:NotAsked	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor
AllergyIntolerance.code.coding:@default	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.reaction.substance	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.substance.coding:NonDrugAllergen	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode
AllergyIntolerance.reaction.substance.coding:CCDD	preferred	https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
AllergyIntolerance.reaction.substance.coding:@default	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.manifestation	example	SNOMEDCTClinicalFindings http://hl7.org/fhir/ValueSet/clinical-findings from the FHIR Standard
AllergyIntolerance.reaction.severity	required	AllergyIntoleranceSeverity http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1 from the FHIR Standard
AllergyIntolerance.reaction.exposureRoute	preferred	https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration

Constraints

Id	Grade	Path(s)	Details	Requirements
ait-1	error	AllergyIntolerance	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	error	AllergyIntolerance	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()
ca-baseline-allergy	error	AllergyIntolerance	AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies verificationStatus.exists()
ca-baseline-allergy-noallergy	error	AllergyIntolerance	if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error : code.coding.where(system = 'http://snomed.info/sct' and code = '716186003').exists() and verificationStatus.coding.where(code = 'unconfirmed').empty()
ca-baseline-allergy-notasked	error	AllergyIntolerance	if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies type.exists().not() and category.exists().not() and criticality.exists().not()
dom-2	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	AllergyIntolerance	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	error	AllergyIntolerance	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	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	AllergyIntolerance	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from AllergyIntolerance

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	AllergyIntolerance	AllergyIntolerance Profile ca-baseline-allergy: AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept ca-baseline-allergy-notasked: if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present ca-baseline-allergy-noallergy: if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error
identifier		0..*	Identifier	External ids for this item
clinicalStatus	?!	0..1	CodeableConcept	active | inactive | resolved
verificationStatus	?!	0..1	CodeableConcept	unconfirmed | confirmed | refuted | entered-in-error
category		0..*	code	food | medication | environment | biologic
code	S	0..1	CodeableConcept	Code that identifies the allergy or intolerance
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NotAsked		0..1	Coding	Code for NOT asked or NOT possible to obtain information about allergy or intolerance Binding: https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor (preferred): Negation/exclusion codes for reporting no known allergies or not available data.
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/v3/NullFlavor
code		1..1	code	Symbol in syntax defined by the system
coding:NoAllergy		0..1	Coding	Code when a patient has been asked and has indicated no history of allergies or intolerance
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 716186003
coding:@default		0..1	Coding	Code defined by a terminology system Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition.
patient	S	1..1	Reference(Patient Profile)	Who the sensitivity is for
encounter		0..1	Reference(Encounter Profile)	Encounter when the allergy or intolerance was asserted
Slices for onsetDateTime				Content/Rules for all slices
onsetDateTime:onsetDateTime		0..1	dateTime	When allergy or intolerance was identified
recorder		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile)	Who recorded the sensitivity
asserter		0..1	Reference(Patient Profile | Practitioner Profile (General) | PractitionerRole Profile (General))	Source of the information about the allergy
reaction
substance		0..1	CodeableConcept	Specific substance or pharmaceutical product considered to be responsible for event
Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NonDrugAllergen		0..*	Coding	Code for the specific non-drug allergen Binding: https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode (preferred): Represents the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction.
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
coding:CCDD		0..*	Coding	Medicinal products for prescribing Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): Represents subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada.
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
code		1..1	code	Symbol in syntax defined by the system
coding:@default		0..*	Coding	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event
exposureRoute		0..1	CodeableConcept	How the subject was exposed to the substance Binding: https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration (preferred): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
AllergyIntolerance.code.coding:NotAsked	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor
AllergyIntolerance.code.coding:@default	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.reaction.substance.coding:NonDrugAllergen	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode
AllergyIntolerance.reaction.substance.coding:CCDD	preferred	https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
AllergyIntolerance.reaction.substance.coding:@default	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.exposureRoute	preferred	https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration

Constraints

Id	Grade	Path(s)	Details	Requirements
ca-baseline-allergy	error	AllergyIntolerance	AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies verificationStatus.exists()
ca-baseline-allergy-noallergy	error	AllergyIntolerance	if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error : code.coding.where(system = 'http://snomed.info/sct' and code = '716186003').exists() and verificationStatus.coding.where(code = 'unconfirmed').empty()
ca-baseline-allergy-notasked	error	AllergyIntolerance	if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies type.exists().not() and category.exists().not() and criticality.exists().not()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	AllergyIntolerance	AllergyIntolerance Profile ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error ca-baseline-allergy: AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept ca-baseline-allergy-notasked: if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present ca-baseline-allergy-noallergy: if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External ids for this item
clinicalStatus	?!ΣC	0..1	CodeableConcept	active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required): The clinical status of the allergy or intolerance.
verificationStatus	?!ΣC	0..1	CodeableConcept	unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required): Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
category	Σ	0..*	code	food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
code	SΣ	0..1	CodeableConcept	Code that identifies the allergy or intolerance Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NotAsked	Σ	0..1	Coding	Code for NOT asked or NOT possible to obtain information about allergy or intolerance Binding: https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor (preferred): Negation/exclusion codes for reporting no known allergies or not available data.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/v3/NullFlavor
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:NoAllergy	Σ	0..1	Coding	Code when a patient has been asked and has indicated no history of allergies or intolerance
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 716186003
coding:@default	Σ	0..1	Coding	Code defined by a terminology system Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition.
patient	SΣ	1..1	Reference(Patient Profile)	Who the sensitivity is for
encounter		0..1	Reference(Encounter Profile)	Encounter when the allergy or intolerance was asserted
Slices for onset[x]		0..1		When allergy or intolerance was identified Slice: Unordered, Open by type:$this
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
onset[x]:onsetDateTime		0..1	dateTime	When allergy or intolerance was identified
recorder		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile)	Who recorded the sensitivity
asserter	Σ	0..1	Reference(Patient Profile | Practitioner Profile (General) | PractitionerRole Profile (General))	Source of the information about the allergy
reaction		0..*	BackboneElement	Adverse Reaction Events linked to exposure to substance
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
substance		0..1	CodeableConcept	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NonDrugAllergen	Σ	0..*	Coding	Code for the specific non-drug allergen Binding: https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode (preferred): Represents the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction.
system	Σ	1..1	uri	Identity of the terminology system
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:CCDD	Σ	0..*	Coding	Medicinal products for prescribing Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): Represents subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada.
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
code	Σ	1..1	code	Symbol in syntax defined by the system
coding:@default	Σ	0..*	Coding	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (example): Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
exposureRoute		0..1	CodeableConcept	How the subject was exposed to the substance Binding: https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration (preferred): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
AllergyIntolerance.clinicalStatus	required	AllergyIntoleranceClinicalStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1 from the FHIR Standard
AllergyIntolerance.verificationStatus	required	AllergyIntoleranceVerificationStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1 from the FHIR Standard
AllergyIntolerance.category	required	AllergyIntoleranceCategory http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1 from the FHIR Standard
AllergyIntolerance.code	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.code.coding:NotAsked	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor
AllergyIntolerance.code.coding:@default	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.reaction.substance	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.substance.coding:NonDrugAllergen	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode
AllergyIntolerance.reaction.substance.coding:CCDD	preferred	https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
AllergyIntolerance.reaction.substance.coding:@default	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.manifestation	example	SNOMEDCTClinicalFindings http://hl7.org/fhir/ValueSet/clinical-findings from the FHIR Standard
AllergyIntolerance.reaction.exposureRoute	preferred	https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration

Constraints

Id	Grade	Path(s)	Details	Requirements
ait-1	error	AllergyIntolerance	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	error	AllergyIntolerance	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()
ca-baseline-allergy	error	AllergyIntolerance	AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies verificationStatus.exists()
ca-baseline-allergy-noallergy	error	AllergyIntolerance	if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error : code.coding.where(system = 'http://snomed.info/sct' and code = '716186003').exists() and verificationStatus.coding.where(code = 'unconfirmed').empty()
ca-baseline-allergy-notasked	error	AllergyIntolerance	if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies type.exists().not() and category.exists().not() and criticality.exists().not()
dom-2	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	AllergyIntolerance	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	error	AllergyIntolerance	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	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	AllergyIntolerance	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	AllergyIntolerance	AllergyIntolerance Profile ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error ca-baseline-allergy: AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept ca-baseline-allergy-notasked: if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present ca-baseline-allergy-noallergy: if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External ids for this item
clinicalStatus	?!ΣC	0..1	CodeableConcept	active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required): The clinical status of the allergy or intolerance.
verificationStatus	?!ΣC	0..1	CodeableConcept	unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required): Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
type	Σ	0..1	code	allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category	Σ	0..*	code	food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality	Σ	0..1	code	low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code	SΣ	0..1	CodeableConcept	Code that identifies the allergy or intolerance Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NotAsked	Σ	0..1	Coding	Code for NOT asked or NOT possible to obtain information about allergy or intolerance Binding: https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor (preferred): Negation/exclusion codes for reporting no known allergies or not available data.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/fhir/v3/NullFlavor
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:NoAllergy	Σ	0..1	Coding	Code when a patient has been asked and has indicated no history of allergies or intolerance
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 716186003
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:@default	Σ	0..1	Coding	Code defined by a terminology system Binding: AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes (example): Type of the substance/product, allergy or intolerance condition.
text	Σ	0..1	string	Plain text representation of the concept
patient	SΣ	1..1	Reference(Patient Profile)	Who the sensitivity is for
encounter		0..1	Reference(Encounter Profile)	Encounter when the allergy or intolerance was asserted
Slices for onset[x]		0..1		When allergy or intolerance was identified Slice: Unordered, Open by type:$this
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
onsetRange			Range
onsetString			string
onset[x]:onsetDateTime		0..1	dateTime	When allergy or intolerance was identified
recordedDate		0..1	dateTime	Date first version of the resource instance was recorded
recorder		0..1	Reference(Practitioner Profile (General) | PractitionerRole Profile (General) | Patient Profile)	Who recorded the sensitivity
asserter	Σ	0..1	Reference(Patient Profile | Practitioner Profile (General) | PractitionerRole Profile (General))	Source of the information about the allergy
lastOccurrence		0..1	dateTime	Date(/time) of last known occurrence of a reaction
note		0..*	Annotation	Additional text not captured in other fields
reaction		0..*	BackboneElement	Adverse Reaction Events linked to exposure to substance
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
substance		0..1	CodeableConcept	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system
coding:NonDrugAllergen	Σ	0..*	Coding	Code for the specific non-drug allergen Binding: https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode (preferred): Represents the specific non-drug allergen or other agent/substance to which the Client has an allergic reaction.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:CCDD	Σ	0..*	Coding	Medicinal products for prescribing Binding: https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct (preferred): Represents subset of codes with commonly used medicinal products that are available for prescribing and dispensing in Canada.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.infoway-inforoute.ca/CodeSystem/canadianclinicaldrugdataset
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:@default	Σ	0..*	Coding	Specific substance or pharmaceutical product considered to be responsible for event Binding: SubstanceCode (example): Codes defining the type of the substance (including pharmaceutical products).
text	Σ	0..1	string	Plain text representation of the concept
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (example): Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
description		0..1	string	Description of the event as a whole
onset		0..1	dateTime	Date(/time) when manifestations showed
severity		0..1	code	mild | moderate | severe (of event as a whole) Binding: AllergyIntoleranceSeverity (required): Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
exposureRoute		0..1	CodeableConcept	How the subject was exposed to the substance Binding: https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration (preferred): A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
note		0..*	Annotation	Text about event not captured in other fields
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
AllergyIntolerance.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
AllergyIntolerance.clinicalStatus	required	AllergyIntoleranceClinicalStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1 from the FHIR Standard
AllergyIntolerance.verificationStatus	required	AllergyIntoleranceVerificationStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1 from the FHIR Standard
AllergyIntolerance.type	required	AllergyIntoleranceType http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1 from the FHIR Standard
AllergyIntolerance.category	required	AllergyIntoleranceCategory http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1 from the FHIR Standard
AllergyIntolerance.criticality	required	AllergyIntoleranceCriticality http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1 from the FHIR Standard
AllergyIntolerance.code	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.code.coding:NotAsked	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor https://fhir.infoway-inforoute.ca/ValueSet/NullFlavor
AllergyIntolerance.code.coding:@default	example	AllergyIntoleranceSubstance/Product,ConditionAndNegationCodes http://hl7.org/fhir/ValueSet/allergyintolerance-code from the FHIR Standard
AllergyIntolerance.reaction.substance	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.substance.coding:NonDrugAllergen	preferred	https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode https://fhir.infoway-inforoute.ca/ValueSet/NonDrugAllergenCode
AllergyIntolerance.reaction.substance.coding:CCDD	preferred	https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct https://fhir.infoway-inforoute.ca/ValueSet/prescriptionmedicinalproduct
AllergyIntolerance.reaction.substance.coding:@default	example	SubstanceCode http://hl7.org/fhir/ValueSet/substance-code from the FHIR Standard
AllergyIntolerance.reaction.manifestation	example	SNOMEDCTClinicalFindings http://hl7.org/fhir/ValueSet/clinical-findings from the FHIR Standard
AllergyIntolerance.reaction.severity	required	AllergyIntoleranceSeverity http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1 from the FHIR Standard
AllergyIntolerance.reaction.exposureRoute	preferred	https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration https://fhir.infoway-inforoute.ca/ValueSet/RouteOfAdministration

Constraints

Id	Grade	Path(s)	Details	Requirements
ait-1	error	AllergyIntolerance	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	error	AllergyIntolerance	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()
ca-baseline-allergy	error	AllergyIntolerance	AllergyIntolerance.verificationStatus SHALL be present if AllergyIntolerance.code represents NullFlavor concept : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies verificationStatus.exists()
ca-baseline-allergy-noallergy	error	AllergyIntolerance	if AllergyIntolerance.code is '716186003' No known allergy, then AllergyIntolerance.verificationStatus SHALL be one of the following: confirmed | refuted | entered-in-error : code.coding.where(system = 'http://snomed.info/sct' and code = '716186003').exists() and verificationStatus.coding.where(code = 'unconfirmed').empty()
ca-baseline-allergy-notasked	error	AllergyIntolerance	if AllergyIntolerance.code is a NullFlavor value, then AllergyIntolerance.clinicalStatus, AllergyIntolerance.type, AllergyIntolerance.category, AllergyIntolerance.criticality SHALL NOT be present : code.coding.where(system = 'http://terminology.hl7.org/CodeSystem/v3-NullFlavor').exists() implies type.exists().not() and category.exists().not() and criticality.exists().not()
dom-2	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	AllergyIntolerance	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	error	AllergyIntolerance	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	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	AllergyIntolerance	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from AllergyIntolerance

Summary

Mandatory: 0 element(8 nested mandatory elements)
Must-Support: 3 elements
Fixed: 4 elements

Structures

This structure refers to these other structures:

• Patient Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-patient)
• Encounter Profile (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-encounter)
• Practitioner Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitioner)
• PractitionerRole Profile (General) (http://hl7.org/fhir/ca/baseline/StructureDefinition/profile-practitionerrole)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of AllergyIntolerance.code.coding (Closed)
• The element 1 is sliced based on the value of AllergyIntolerance.reaction.substance.coding (Closed)

Verification Status

The AllergyIntolerance.verificationStatus element is optional (i.e., cardinality is 0..1) in this profile since a typical use would involve clinical decision support that produces warnings when potentially dangerous medications/treatments might be prescribed.

There is potential for confounding/conflicting information if verification status "overrides" a clinical finding of an allergy or intolerance.

In addition allergies/intolerance are usually reported by the patient and rarely verified probable that this information is not collected and not available, therefore data element is not populated except by default (presumably as "unconfirmed") again leading to problematic data for clinical decision support.

This is also problematic with respect to interoperability considerations.

Code

If the AllergyIntolerance.code element represents NullFlavor concept (i.e., no known allergy) then the verificationStatus element SHALL be present.

Rational is that recording "no known allergy" without an assessment would a patient safety issue and should not happen. It is not consistent with clinical practice.

Substance

The identification of the specific substance (or pharmaceutical product) considered to be responsible for the Adverse Reaction event uses Substance Code value set with Example binding. Consider use Canadian Clinical Drug Data set in case of medication allergy/intolerance, and SNOMED CT for other substances/agents.

Manifestation

The AllergyIntolerance.reaction.manifestation element is a required element to provide symptoms and/or signs that are observed or associated with the adverse reaction event.

-Consider developing a value set from MEDDRA for drug reactions