# US Core AllergyIntolerance Profile - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core AllergyIntolerance Profile**

## Resource Profile: US Core AllergyIntolerance Profile 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance | *Version*:9.0.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](changes-between-versions.md#us-core-maturity-levels): 5 | *Computable Name*:USCoreAllergyIntolerance |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.5 | | |

 
The US Core AllergyIntolerance Profile inherits from the FHIR [AllergyIntolerance](https://hl7.org/fhir/R4/allergyintolerance.html) resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the AllergyIntolerance resource to record, search, and fetch allergies/adverse reactions associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption. 

**Example Usage Scenarios:**

The following are example usage scenarios for the US Core AllergyIntolerance profile:

* Query for Allergies belonging to a Patient
* [Record or update](us-core-roadmap.md#future-candidate-requirements-under-consideration) a Patient Allergy

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory](must-support.md) definition) or must be supported if the data is present in the sending system ([Must Support](must-support.md) definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The [Formal Views](#profile) below provides the formal summary, definitions, and terminology requirements.

**Each AllergyIntolerance Must Have:**

1. a clinical status of the allergy (e.g., active or resolved)1
1. a code that tells you what the patient is allergic to
1. a patient

**Each AllergyIntolerance Must Support:**

1. a verification status
1. a reaction manifestation

**Additional USCDI Requirements:**

These [Additional USCDI Requirements](must-support.md#additional-uscdi-requirements) elements are not Mandatory or Must Support but are required for ONC Health IT certification testing and are included in the formal definition of the profile and the AllergyIntolerance examples.

1. a recorder2

1,2 see guidance below

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

* 1 The `AllergyIntolerance.clinicalStatus` element has the following constraints: **SHALL** be present if verification status is not "entered-in-error"[§](requirements.md#CONF-0302) and **SHALL NOT** be present if verification Status is "entered-in-error".[§](requirements.md#CONF-0303)
* **No Known Allergies** **MAY** be represented using the US Core-AllergyIntolerance profile[§](requirements.md#CONF-0305) with the appropriate negation code in `AllergyIntolerance.code`[§](requirements.md#CONF-0306) and the appropriate verification status in `AllergyIntolerance.verificationStatus`.[§](requirements.md#CONF-0307)


  If a patient has not been asked about their allergies, this would be represented as:[§](requirements.md#CONF-0308)


  If a patient has been asked, but has indicated they have no known allergies, this would be represented as:[§](requirements.md#CONF-0309)

* 2 The profile elements `AllergyIntolerance.asserter and AllergyIntolerance.recorder` communicate the [individual level provenance](basic-provenance.md#individual-level-provenance) author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

**Usages:**

* Examples for this Profile: [AllergyIntolerance/example](AllergyIntolerance-example.md) and [AllergyIntolerance/non-pharmacologic-agent-example](AllergyIntolerance-non-pharmacologic-agent-example.md)
* CapabilityStatements using this Profile: [US Core Client CapabilityStatement](CapabilityStatement-us-core-client.md) and [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.core|current/StructureDefinition/us-core-allergyintolerance)

**Changes since version 8.0.1:**

* The resource metadata has changed (copyright)

* The data elements list has changed

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-allergyintolerance.csv), [Excel](StructureDefinition-us-core-allergyintolerance.xlsx), [Schematron](StructureDefinition-us-core-allergyintolerance.sch) 

### Notes:

-------

**Quick Start**  

-------

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile's information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md) for a complete list of supported RESTful interactions for this IG.

* See the [Scopes Format](scopes.md#scopes-format) section for a description of the SMART scopes syntax.
* See the [Search Syntax](general-guidance.md#search-syntax) section for a description of the US Core search syntax.
* See the [General Requirements](general-requirements.md) section for additional rules and expectations when a Server requires status parameters.
* See the [General Guidance](general-guidance.md) section for additional guidance on searching for multiple patients.

#### US Core Scopes

Servers providing access to allergy and intolerance data **SHALL** support these [US Core SMART Scopes](scopes.md#smart-scopes):

* [resource level scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#scopes-for-requesting-clinical-data): `<patient|user|system>/AllergyIntolerance.rs` [§](requirements.md#CONF-0132)

-------

#### Mandatory Search Parameters:

The following search parameters and search parameter combinations **SHALL** be supported:

1. **SHALL** support searching for all allergies for a patient using the [patient](SearchParameter-us-core-allergyintolerance-patient.md) search parameter`GET [base]/AllergyIntolerance?patient={Patient/}[id]`Example:
> 
1. GET [base]/AllergyIntolerance?patient=Patient/1137192

**Implementation Notes**: Fetches a bundle of all US Core AllergyIntolerance Profile resources for the specified patient ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference)).

#### Optional Search Parameters:

The following search parameters and search parameter combinations **SHOULD** be supported

1. **SHOULD** support searching using the combination of the [patient](SearchParameter-us-core-allergyintolerance-patient.md) and [clinical-status](SearchParameter-us-core-allergyintolerance-clinical-status.md) search parameters`GET [base]/AllergyIntolerance?patient={Patient/}[id]&clinical-status={system|}[search_code]`Example:
> 
1. GET [base]/AllergyIntolerance?patient=Patient/1137192&clinical-status=http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical|active

**Implementation Notes**: Fetches a bundle of all US Core AllergyIntolerance Profile resources for the specified patient and status code. This will not return any "entered in error" resources because of the conditional presence of the clinicalStatus element. ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-allergyintolerance",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 5
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.5"
  }],
  "version" : "9.0.0",
  "name" : "USCoreAllergyIntolerance",
  "title" : "US Core AllergyIntolerance Profile",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-10-17",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The US Core AllergyIntolerance Profile inherits from the FHIR [AllergyIntolerance](https://hl7.org/fhir/R4/allergyintolerance.html) resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the AllergyIntolerance resource to record, search, and fetch allergies/adverse reactions associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets **SHALL** be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "AllergyIntolerance",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "AllergyIntolerance",
      "path" : "AllergyIntolerance",
      "mustSupport" : false
    },
    {
      "id" : "AllergyIntolerance.clinicalStatus",
      "path" : "AllergyIntolerance.clinicalStatus",
      "mustSupport" : true,
      "binding" : {
        "strength" : "required",
        "valueSet" : "http://hl7.org/fhir/ValueSet/allergyintolerance-clinical"
      }
    },
    {
      "id" : "AllergyIntolerance.verificationStatus",
      "path" : "AllergyIntolerance.verificationStatus",
      "mustSupport" : true,
      "binding" : {
        "strength" : "required",
        "valueSet" : "http://hl7.org/fhir/ValueSet/allergyintolerance-verification"
      }
    },
    {
      "id" : "AllergyIntolerance.code",
      "path" : "AllergyIntolerance.code",
      "min" : 1,
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.43"
      }
    },
    {
      "id" : "AllergyIntolerance.patient",
      "path" : "AllergyIntolerance.patient",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "AllergyIntolerance.recorder",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "AllergyIntolerance.recorder",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the sensitivity",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }]
    },
    {
      "id" : "AllergyIntolerance.reaction",
      "path" : "AllergyIntolerance.reaction",
      "mustSupport" : true
    },
    {
      "id" : "AllergyIntolerance.reaction.manifestation",
      "path" : "AllergyIntolerance.reaction.manifestation",
      "mustSupport" : true,
      "binding" : {
        "strength" : "extensible",
        "valueSet" : "http://hl7.org/fhir/ValueSet/clinical-findings"
      }
    }]
  }
}

```
