QI-Core Implementation Guide
7.0.2 - STU 7

QI-Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 7.0.2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-qi-core/ and changes regularly. See the Directory of published versions

## Resource Profile: QICore AllergyIntolerance

Official URL: http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance | Version: 7.0.2
Standards status: Trial-use | Maturity Level: 4 | Computable Name: QICoreAllergyIntolerance

Profile of AllergyIntolerance for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

"Must Have", "QI Elements" and "primary code path" are defined in the QI-Core Must Support section.
Must Have:

- patient: (QI) Who the sensitivity is for
- code: (QI) Code that identifies the allergy or intolerance

QI Elements:

- verificationStatus: (QI) unconfirmed | confirmed | refuted | entered-in-error
- onset[x]: (QI) When allergy or intolerance was identified
- clinicalStatus: (QI) active | inactive | resolved
- criticality: (QI) low | high | unable-to-assess
- recordedDate: (QI) Date first version of the resource instance was recorded
- type: (QI) allergy | intolerance - Underlying mechanism (if known)
- category: (QI) food | medication | environment | biologic
- lastOccurrence: (QI) Date(/time) of last known occurrence of a reaction
- reaction: (QI) Adverse Reaction Events linked to exposure to substance

Primary code path: code
(PCPath) This element is the primary code path for this resource CQL Retrieve
Usage

This example represents a situation where the subject is currently experiencing, or is at risk of, a reaction to the identified substance.

    define "Statin Allergy Intolerance":
      ["AllergyIntolerance": "Statin Allergen"] StatinAllergyIntolerance
        where (StatinAllergyIntolerance.clinicalStatus is null or StatinAllergyIntolerance.clinicalStatus ~ Global."allergy-active")

See the patterns page for implementation and usage patterns.

### Examples

Typical Food Allergy
Refuted Food Allergy

Usages:

- Refer to this Profile: QICore AdverseEvent and QICore ImmunizationRecommendation
- Examples for this Profile: AllergyIntolerance/example-refuted and AllergyIntolerance/example

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance | C | 0..* | USCoreAllergyIntolerance | Allergy or Intolerance (generally: Risk of adverse reaction to a substance) Constraints: ait-1, ait-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
clinicalStatus | ?!S Σ C | 0..1 | CodeableConcept | (QI) active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | ?!S Σ C | 0..1 | CodeableConcept | (QI) unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
type | Σ | 0..1 | code | (QI) allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category | Σ | 0..* | code | (QI) food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality | Σ | 0..1 | code | (QI) low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code | S Σ | 1..1 | CodeableConcept | (QI) Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who the sensitivity is for
onset[x] |  | 0..1 |  | (QI) When allergy or intolerance was identified
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
recordedDate |  | 0..1 | dateTime | (QI) Date first version of the resource instance was recorded
lastOccurrence |  | 0..1 | dateTime | (QI) Date(/time) of last known occurrence of a reaction
reaction | S | 0..* | BackboneElement | (QI) Adverse Reaction Events linked to exposure to substance
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
manifestation | S | 1..* | CodeableConcept | Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (extensible)
severity |  | 0..1 | code | (QI) 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.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
AllergyIntolerance.clinicalStatus | Base | required | AllergyIntolerance Clinical Status Codes | 📦4.0.1 | FHIR Std.
AllergyIntolerance.verificationStatus | Base | required | AllergyIntolerance Verification Status Codes | 📦4.0.1 | FHIR Std.
AllergyIntolerance.type | Base | required | AllergyIntoleranceType | 📍4.0.1 | FHIR Std.
AllergyIntolerance.category | Base | required | AllergyIntoleranceCategory | 📍4.0.1 | FHIR Std.
AllergyIntolerance.criticality | Base | required | AllergyIntoleranceCriticality | 📍4.0.1 | FHIR Std.
AllergyIntolerance.code | Base | extensible | Common substances for allergy and intolerance documentation including refutations | 📦20210622 | VSAC v0.18
AllergyIntolerance.reaction.​manifestation | Base | extensible | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.
AllergyIntolerance.reaction.​severity | Base | required | AllergyIntoleranceSeverity | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
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 USCoreAllergyIntolerance

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance |  | 0..* | USCoreAllergyIntolerance | Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
clinicalStatus |  | 0..1 | CodeableConcept | (QI) active | inactive | resolved
verificationStatus | S | 0..1 | CodeableConcept | (QI) unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
type |  | 0..1 | code | (QI) allergy | intolerance - Underlying mechanism (if known)
category |  | 0..* | code | (QI) food | medication | environment | biologic
criticality |  | 0..1 | code | (QI) low | high | unable-to-assess
code |  | 1..1 | CodeableConcept | (QI) Code that identifies the allergy or intolerance
patient |  | 1..1 | Reference(QICore Patient) | (QI) Who the sensitivity is for
onset[x] |  | 0..1 |  | (QI) When allergy or intolerance was identified
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
recordedDate |  | 0..1 | dateTime | (QI) Date first version of the resource instance was recorded
lastOccurrence |  | 0..1 | dateTime | (QI) Date(/time) of last known occurrence of a reaction
reaction |  | 0..* | BackboneElement | (QI) Adverse Reaction Events linked to exposure to substance
severity |  | 0..1 | code | (QI) mild | moderate | severe (of event as a whole)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
AllergyIntolerance.verificationStatus | Base | required | AllergyIntolerance Verification Status Codes | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance | C | 0..* | USCoreAllergyIntolerance | Allergy or Intolerance (generally: Risk of adverse reaction to a substance) Constraints: ait-1, ait-2
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | ?!S Σ C | 0..1 | CodeableConcept | (QI) active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | ?!S Σ C | 0..1 | CodeableConcept | (QI) unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
type | Σ | 0..1 | code | (QI) allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category | Σ | 0..* | code | (QI) food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality | Σ | 0..1 | code | (QI) low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code | S Σ | 1..1 | CodeableConcept | (QI) Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who the sensitivity is for
encounter |  | 0..1 | Reference(Encounter) | Encounter when the allergy or intolerance was asserted
onset[x] |  | 0..1 |  | (QI) When allergy or intolerance was identified
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
recordedDate |  | 0..1 | dateTime | (QI) Date first version of the resource instance was recorded
recorder |  | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) | Who recorded the sensitivity
asserter | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Source of the information about the allergy
lastOccurrence |  | 0..1 | dateTime | (QI) Date(/time) of last known occurrence of a reaction
note |  | 0..* | Annotation | Additional text not captured in other fields
reaction | S | 0..* | BackboneElement | (QI) 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).
manifestation | S | 1..* | CodeableConcept | Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (extensible)
description |  | 0..1 | string | Description of the event as a whole
onset |  | 0..1 | dateTime | Date(/time) when manifestations showed
severity |  | 0..1 | code | (QI) 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: SNOMEDCTRouteCodes (example): 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 | Status | Usage | ValueSet | Version | Source
AllergyIntolerance.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
AllergyIntolerance.clinicalStatus | Base | required | AllergyIntolerance Clinical Status Codes | 📦4.0.1 | FHIR Std.
AllergyIntolerance.verificationStatus | Base | required | AllergyIntolerance Verification Status Codes | 📦4.0.1 | FHIR Std.
AllergyIntolerance.type | Base | required | AllergyIntoleranceType | 📍4.0.1 | FHIR Std.
AllergyIntolerance.category | Base | required | AllergyIntoleranceCategory | 📍4.0.1 | FHIR Std.
AllergyIntolerance.criticality | Base | required | AllergyIntoleranceCriticality | 📍4.0.1 | FHIR Std.
AllergyIntolerance.code | Base | extensible | Common substances for allergy and intolerance documentation including refutations | 📦20210622 | VSAC v0.18
AllergyIntolerance.reaction.​substance | Base | example | Substance Code | 📦4.0.1 | FHIR Std.
AllergyIntolerance.reaction.​manifestation | Base | extensible | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.
AllergyIntolerance.reaction.​severity | Base | required | AllergyIntoleranceSeverity | 📍4.0.1 | FHIR Std.
AllergyIntolerance.reaction.​exposureRoute | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
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 USCoreAllergyIntolerance

Summary

Mandatory: 1 element
Must-Support: 1 element

Structures

This structure refers to these other structures:

- QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)

Maturity: 4

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance | C | 0..* | USCoreAllergyIntolerance | Allergy or Intolerance (generally: Risk of adverse reaction to a substance) Constraints: ait-1, ait-2
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
clinicalStatus | ?!S Σ C | 0..1 | CodeableConcept | (QI) active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | ?!S Σ C | 0..1 | CodeableConcept | (QI) unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
type | Σ | 0..1 | code | (QI) allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category | Σ | 0..* | code | (QI) food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality | Σ | 0..1 | code | (QI) low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code | S Σ | 1..1 | CodeableConcept | (QI) Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who the sensitivity is for
onset[x] |  | 0..1 |  | (QI) When allergy or intolerance was identified
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
recordedDate |  | 0..1 | dateTime | (QI) Date first version of the resource instance was recorded
lastOccurrence |  | 0..1 | dateTime | (QI) Date(/time) of last known occurrence of a reaction
reaction | S | 0..* | BackboneElement | (QI) Adverse Reaction Events linked to exposure to substance
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
manifestation | S | 1..* | CodeableConcept | Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (extensible)
severity |  | 0..1 | code | (QI) 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.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
AllergyIntolerance.clinicalStatus | Base | required | AllergyIntolerance Clinical Status Codes | 📦4.0.1 | FHIR Std.
AllergyIntolerance.verificationStatus | Base | required | AllergyIntolerance Verification Status Codes | 📦4.0.1 | FHIR Std.
AllergyIntolerance.type | Base | required | AllergyIntoleranceType | 📍4.0.1 | FHIR Std.
AllergyIntolerance.category | Base | required | AllergyIntoleranceCategory | 📍4.0.1 | FHIR Std.
AllergyIntolerance.criticality | Base | required | AllergyIntoleranceCriticality | 📍4.0.1 | FHIR Std.
AllergyIntolerance.code | Base | extensible | Common substances for allergy and intolerance documentation including refutations | 📦20210622 | VSAC v0.18
AllergyIntolerance.reaction.​manifestation | Base | extensible | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.
AllergyIntolerance.reaction.​severity | Base | required | AllergyIntoleranceSeverity | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
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 USCoreAllergyIntolerance

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance |  | 0..* | USCoreAllergyIntolerance | Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
clinicalStatus |  | 0..1 | CodeableConcept | (QI) active | inactive | resolved
verificationStatus | S | 0..1 | CodeableConcept | (QI) unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
type |  | 0..1 | code | (QI) allergy | intolerance - Underlying mechanism (if known)
category |  | 0..* | code | (QI) food | medication | environment | biologic
criticality |  | 0..1 | code | (QI) low | high | unable-to-assess
code |  | 1..1 | CodeableConcept | (QI) Code that identifies the allergy or intolerance
patient |  | 1..1 | Reference(QICore Patient) | (QI) Who the sensitivity is for
onset[x] |  | 0..1 |  | (QI) When allergy or intolerance was identified
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
recordedDate |  | 0..1 | dateTime | (QI) Date first version of the resource instance was recorded
lastOccurrence |  | 0..1 | dateTime | (QI) Date(/time) of last known occurrence of a reaction
reaction |  | 0..* | BackboneElement | (QI) Adverse Reaction Events linked to exposure to substance
severity |  | 0..1 | code | (QI) mild | moderate | severe (of event as a whole)
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
AllergyIntolerance.verificationStatus | Base | required | AllergyIntolerance Verification Status Codes | 📦4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance | C | 0..* | USCoreAllergyIntolerance | Allergy or Intolerance (generally: Risk of adverse reaction to a substance) Constraints: ait-1, ait-2
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | ?!S Σ C | 0..1 | CodeableConcept | (QI) active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | ?!S Σ C | 0..1 | CodeableConcept | (QI) unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
type | Σ | 0..1 | code | (QI) allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category | Σ | 0..* | code | (QI) food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality | Σ | 0..1 | code | (QI) low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code | S Σ | 1..1 | CodeableConcept | (QI) Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S Σ | 1..1 | Reference(QICore Patient) | (QI) Who the sensitivity is for
encounter |  | 0..1 | Reference(Encounter) | Encounter when the allergy or intolerance was asserted
onset[x] |  | 0..1 |  | (QI) When allergy or intolerance was identified
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
recordedDate |  | 0..1 | dateTime | (QI) Date first version of the resource instance was recorded
recorder |  | 0..1 | Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) | Who recorded the sensitivity
asserter | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | Source of the information about the allergy
lastOccurrence |  | 0..1 | dateTime | (QI) Date(/time) of last known occurrence of a reaction
note |  | 0..* | Annotation | Additional text not captured in other fields
reaction | S | 0..* | BackboneElement | (QI) 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).
manifestation | S | 1..* | CodeableConcept | Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (extensible)
description |  | 0..1 | string | Description of the event as a whole
onset |  | 0..1 | dateTime | Date(/time) when manifestations showed
severity |  | 0..1 | code | (QI) 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: SNOMEDCTRouteCodes (example): 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 | Status | Usage | ValueSet | Version | Source
AllergyIntolerance.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std.
AllergyIntolerance.clinicalStatus | Base | required | AllergyIntolerance Clinical Status Codes | 📦4.0.1 | FHIR Std.
AllergyIntolerance.verificationStatus | Base | required | AllergyIntolerance Verification Status Codes | 📦4.0.1 | FHIR Std.
AllergyIntolerance.type | Base | required | AllergyIntoleranceType | 📍4.0.1 | FHIR Std.
AllergyIntolerance.category | Base | required | AllergyIntoleranceCategory | 📍4.0.1 | FHIR Std.
AllergyIntolerance.criticality | Base | required | AllergyIntoleranceCriticality | 📍4.0.1 | FHIR Std.
AllergyIntolerance.code | Base | extensible | Common substances for allergy and intolerance documentation including refutations | 📦20210622 | VSAC v0.18
AllergyIntolerance.reaction.​substance | Base | example | Substance Code | 📦4.0.1 | FHIR Std.
AllergyIntolerance.reaction.​manifestation | Base | extensible | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.
AllergyIntolerance.reaction.​severity | Base | required | AllergyIntoleranceSeverity | 📍4.0.1 | FHIR Std.
AllergyIntolerance.reaction.​exposureRoute | Base | example | SNOMED CT Route Codes | 📦4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
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()`
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 USCoreAllergyIntolerance

Summary

Mandatory: 1 element
Must-Support: 1 element

Structures

This structure refers to these other structures:

- QICore Patient (http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient)

Maturity: 4

Other representations of profile: CSV, Excel, Schematron