QI-Core Implementation Guide
4.1.0 - release

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## : AllergyIntrolerance example - XML Representation

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    <AllergyIntolerance xmlns="http://hl7.org/fhir">
      <id value="example"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"/>
      </meta>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource "example" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-qicore-allergyintolerance.html">QICoreAllergyIntolerance</a></p></div><p><b>identifier</b>: id: 49476534</p><p><b>clinicalStatus</b>: Active <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-allergyintolerance-clinical.html">AllergyIntolerance Clinical Status Codes</a>#active)</span></p><p><b>verificationStatus</b>: Confirmed <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-allergyintolerance-verification.html">AllergyIntolerance Verification Status</a>#confirmed)</span></p><p><b>type</b>: allergy</p><p><b>category</b>: food</p><p><b>criticality</b>: high</p><p><b>code</b>: Cashew nuts <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#227493005)</span></p><p><b>patient</b>: <a href="Patient-example.html">Patient/example</a> " CHALMERS"</p><p><b>onset</b>: 2004-01-01</p><p><b>recordedDate</b>: 2014-10-09T14:58:00+11:00</p><p><b>recorder</b>: <a href="Practitioner-example.html">Practitioner/example</a> " CAREFUL"</p><p><b>asserter</b>: <a href="Patient-example.html">Patient/example</a> " CHALMERS"</p><p><b>lastOccurrence</b>: 2012-06-02T01:45:31Z</p><p><b>note</b>: The criticality is high becasue of the observed anaphylactic reaction when challenged     with cashew extract.</p><blockquote><p><b>reaction</b></p><p><b>substance</b>: cashew nut allergenic extract Injectable Product <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-rxNorm.html">RxNorm</a>#1160593)</span></p><p><b>manifestation</b>: Anaphylactic reaction <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#39579001)</span></p><p><b>description</b>: Challenge Protocol. Severe reaction to subcutaneous cashew extract. Epinephrine administered</p><p><b>onset</b>: 2012-06-12</p><p><b>severity</b>: severe</p><p><b>exposureRoute</b>: Subcutaneous route <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#34206005)</span></p></blockquote><blockquote><p><b>reaction</b></p><p><b>manifestation</b>: Urticaria <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#64305001)</span></p><p><b>onset</b>: 2004-01-01</p><p><b>severity</b>: moderate</p><p><b>note</b>: The patient reports that the onset of urticaria was within 15 minutes of eating cashews.</p></blockquote></div>
      </text>
    <!--     an identifier used for this allergic propensity (adverse reaction risk)     -->
      <identifier>
        <system value="http://acme.com/ids/patients/risks"/>
        <value value="49476534"/>
      </identifier>
    <!--     this individual has had several reactions     -->
      <clinicalStatus>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"/>
          <code value="active"/>
        </coding>
      </clinicalStatus>
      <verificationStatus>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"/>
          <code value="confirmed"/>
        </coding>
      </verificationStatus>
    <!--     note: it's often unknown whether an allergy is mediated by an immune response, and
       not as significant as once thought     -->
      <type value="allergy"/>
    <!--     this categorisation is implied by "cashew nut" and therefore basically
        redundant, but many systems collect this field anyway, since it's either
        useful when the substance is not coded, or it's quicker to sort/filter on
        than using terminology based reasoning     -->
      <category value="food"/>
    <!--     there is no question that the allergy is real and serious     -->
      <criticality value="high"/>
    <!--     Allergy or intolerance code (substance, product, condition or negated/excluded statement)
       or text. A few times,
        there's a full description of a complex substance/product - in these caes, use the
        extension [url] to refer to a Substance resource.     -->
      <code>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="227493005"/>
          <display value="Cashew nuts"/>
        </coding>
      </code>
    <!--     the patient that actually has the risk of adverse reaction     -->
      <patient>
        <reference value="Patient/example"/>
      </patient>
    <!--     when the allergy was first noted (in this case the same as reaction.onset of the first
       occurrence)     -->
      <onsetDateTime value="2004"/>
    <!--     the date that this entry was recorded     -->
      <recordedDate value="2014-10-09T14:58:00+11:00"/>
    <!--     who made the record / last updated it     -->
      <recorder>
        <reference value="Practitioner/example"/>
      </recorder>
    <!--     the patient is the reporter in this case     -->
      <asserter>
        <reference value="Patient/example"/>
      </asserter>
    <!--     last happened June 2012. Typically, systems either track lastOccurrence,
         or a list of events.     -->
      <lastOccurrence value="2012-06-02T01:45:31+00:00"/>
    <!--     an additional note about the allergy propensity by the recorder     -->
      <note>
        <text
              value="The criticality is high becasue of the observed anaphylactic reaction when challenged     with cashew extract."/>
      </note>
    <!--     past events. There's no claim that this is all the events, and
         that should not be assumed     -->
      <reaction>
      <!--
          It's possible to list specific things to which the patient responded,
          e.g. chocolate (that happened to contain cashew nuts). This event has
          such a specific substance. Note that systems should ensure that what
          goes in here does not conflict with the substance above, and systems
          processing the data can be sure that what is here does not contravene
          the substance above
            -->
        <substance>
          <coding>
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
            <code value="1160593"/>
            <display value="cashew nut allergenic extract Injectable Product"/>
          </coding>
        </substance>
        <manifestation>
          <coding>
            <system value="http://snomed.info/sct"/>
            <code value="39579001"/>
            <display value="Anaphylactic reaction"/>
          </coding>
        </manifestation>
        <description
                     value="Challenge Protocol. Severe reaction to subcutaneous cashew extract. Epinephrine administered"/>
        <onset value="2012-06-12"/>
        <severity value="severe"/>
        <exposureRoute>
          <coding>
            <system value="http://snomed.info/sct"/>
            <code value="34206005"/>
            <display value="Subcutaneous route"/>
          </coding>
        </exposureRoute>
      </reaction>
    <!--     this was the first occurrence     -->
      <reaction>
        <manifestation>
          <coding>
            <system value="http://snomed.info/sct"/>
            <code value="64305001"/>
            <display value="Urticaria"/>
          </coding>
        </manifestation>
        <onset value="2004"/>
        <severity value="moderate"/>
      <!--     an additional note about the reaction by the recorder     -->
        <note>
          <text
                value="The patient reports that the onset of urticaria was within 15 minutes of eating cashews."/>
        </note>
      </reaction>
    </AllergyIntolerance>