US Core Implementation Guide
8.0.1 - STU 8

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 8.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

## Resource Profile: US Core AllergyIntolerance Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance | Version: 8.0.1
Standards status: Trial-use | Maturity Level: 3 | Computable Name: USCoreAllergyIntolerance
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.5
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core AllergyIntolerance Profile inherits from the FHIR AllergyIntolerance 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 a Patient Allergy

### Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views 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)*
2. a code that tells you what the patient is allergic to
3. a patient

Each AllergyIntolerance Must Support:

1. a verification status
2. a reaction manifestation

Additional USCDI Requirements:

These Additional USCDI Requirements elements are not Mandatory or Must Support but are required for ASTP Health IT certification testing and are included in the formal definition of the profile and the AllergyIntolerance examples.

1. a recorder*

*see guidance below

Profile Specific Implementation Guidance:

- * The `AllergyIntolerance.clinicalStatus` element has the following constraints: SHALL be present if verification status is not "entered-in-error" and SHALL NOT be present if verification Status is "entered-in-error".

- No Known Allergies may be represented using the US Core-AllergyIntolerance profile with the appropriate negation code in `AllergyIntolerence.code` and the appropriate verification status in `AllergyIntolerance.verificationStatus`.

  If a patient has not been asked about their allergies, this would be represented as:

  - `AllergyIntolerance.code` = "1631000175102" (Patient not asked (contextual qualifier) (qualifier value))
  - `AllergyIntolerance.verificationStatus` = "unconfirmed" or empty (in other words, then element omitted)

  If a patient has been asked, but has indicated they have no known allergies, this would be represented as:

  - `AllergyIntolerance.code` = "716186003" (No known allergy (situation))
  - `AllergyIntolerance.verificationStatus` = "confirmed"

- *The profile elements `AllergyIntolerance.asserter and AllergyIntolerance.recorder` communicate the 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 and AllergyIntolerance/non-pharmacologic-agent-example
- CapabilityStatements using this Profile: US Core Client CapabilityStatement and US Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

Changes since version 7.0.0:

- The data elements list has changed

### 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..* | AllergyIntolerance | 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 | active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | ?!S Σ C | 0..1 | CodeableConcept | unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
code | S Σ | 1..1 | CodeableConcept | Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S Σ | 1..1 | Reference(US Core Patient Profile) | Who the sensitivity is for
recorder |  | 0..1 | Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the sensitivity
reaction | S | 0..* | BackboneElement | 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)
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.code | Base | extensible | Common substances for allergy and intolerance documentation including refutations | 📦20240625 | VSAC v0.24
AllergyIntolerance.reaction.​manifestation | Base | extensible | SNOMED CT Clinical Findings | 📦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 AllergyIntolerance

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance |  | 0..* | AllergyIntolerance | Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
clinicalStatus | S | 0..1 | CodeableConcept | active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | S | 0..1 | CodeableConcept | unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
code | S | 1..1 | CodeableConcept | Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S | 1..1 | Reference(US Core Patient Profile) | Who the sensitivity is for
recorder |  | 0..1 | Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the sensitivity
reaction | S | 0..* | BackboneElement | Adverse Reaction Events linked to exposure to substance
manifestation | S | 1..* | CodeableConcept | Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (extensible)
Documentation for this format

#### Terminology Bindings (Differential)

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.code | Base | extensible | Common substances for allergy and intolerance documentation including refutations | 📦20240625 | VSAC v0.24
AllergyIntolerance.reaction.​manifestation | Base | extensible | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance | C | 0..* | AllergyIntolerance | 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 | active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | ?!S Σ C | 0..1 | CodeableConcept | unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
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 | S Σ | 1..1 | CodeableConcept | Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S Σ | 1..1 | Reference(US Core Patient Profile) | Who the sensitivity is for
encounter |  | 0..1 | Reference(Encounter) | Encounter when the allergy or intolerance was asserted
onset[x] |  | 0..1 |  | When allergy or intolerance was identified
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
onsetString |  |  | string |
recordedDate |  | 0..1 | dateTime | Date first version of the resource instance was recorded
recorder |  | 0..1 | Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the sensitivity
asserter | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | 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 | S | 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).
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 | 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 | 📦20240625 | VSAC v0.24
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 AllergyIntolerance

Summary

Mandatory: 1 element
Must-Support: 6 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

Maturity: 3

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance | C | 0..* | AllergyIntolerance | 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 | active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | ?!S Σ C | 0..1 | CodeableConcept | unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
code | S Σ | 1..1 | CodeableConcept | Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S Σ | 1..1 | Reference(US Core Patient Profile) | Who the sensitivity is for
recorder |  | 0..1 | Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the sensitivity
reaction | S | 0..* | BackboneElement | 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)
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.code | Base | extensible | Common substances for allergy and intolerance documentation including refutations | 📦20240625 | VSAC v0.24
AllergyIntolerance.reaction.​manifestation | Base | extensible | SNOMED CT Clinical Findings | 📦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 AllergyIntolerance

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance |  | 0..* | AllergyIntolerance | Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
clinicalStatus | S | 0..1 | CodeableConcept | active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | S | 0..1 | CodeableConcept | unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
code | S | 1..1 | CodeableConcept | Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S | 1..1 | Reference(US Core Patient Profile) | Who the sensitivity is for
recorder |  | 0..1 | Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the sensitivity
reaction | S | 0..* | BackboneElement | Adverse Reaction Events linked to exposure to substance
manifestation | S | 1..* | CodeableConcept | Clinical symptoms/signs associated with the Event Binding: SNOMEDCTClinicalFindings (extensible)
Documentation for this format

#### Terminology Bindings (Differential)

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.code | Base | extensible | Common substances for allergy and intolerance documentation including refutations | 📦20240625 | VSAC v0.24
AllergyIntolerance.reaction.​manifestation | Base | extensible | SNOMED CT Clinical Findings | 📦4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
AllergyIntolerance | C | 0..* | AllergyIntolerance | 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 | active | inactive | resolved Binding: AllergyIntoleranceClinicalStatusCodes (required)
verificationStatus | ?!S Σ C | 0..1 | CodeableConcept | unconfirmed | confirmed | refuted | entered-in-error Binding: AllergyIntoleranceVerificationStatusCodes (required)
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 | S Σ | 1..1 | CodeableConcept | Code that identifies the allergy or intolerance Binding: Common substances for allergy and intolerance documentation including refutations (extensible)
patient | S Σ | 1..1 | Reference(US Core Patient Profile) | Who the sensitivity is for
encounter |  | 0..1 | Reference(Encounter) | Encounter when the allergy or intolerance was asserted
onset[x] |  | 0..1 |  | When allergy or intolerance was identified
onsetDateTime |  |  | dateTime |
onsetAge |  |  | Age |
onsetPeriod |  |  | Period |
onsetRange |  |  | Range |
onsetString |  |  | string |
recordedDate |  | 0..1 | dateTime | Date first version of the resource instance was recorded
recorder |  | 0..1 | Reference(US Core Practitioner Profile | US Core Patient Profile | PractitionerRole | US Core RelatedPerson Profile) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who recorded the sensitivity
asserter | Σ | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) | 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 | S | 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).
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 | 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 | 📦20240625 | VSAC v0.24
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 AllergyIntolerance

Summary

Mandatory: 1 element
Must-Support: 6 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

Maturity: 3

Other representations of profile: CSV, Excel, Schematron

### 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 for a complete list of supported RESTful interactions for this IG.

- See the Scopes Format section for a description of the SMART scopes syntax.
- See the Search Syntax section for a description of the US Core search syntax.
- See the General Requirements section for additional rules and expectations when a Server requires status parameters.
- See the General Guidance 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:

- resource level scopes: `<patient|user|system>/AllergyIntolerance.rs`

#### 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` search parameter:

   `GET [base]/AllergyIntolerance?patient={Type/}[id]`

   Example:

   1. GET [base]/AllergyIntolerance?patient=1137192

   Implementation Notes: Fetches a bundle of all AllergyIntolerance resources for the specified patient (how to search by reference)

#### Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the `patient` and `clinical-status` search parameters:

   `GET [base]/AllergyIntolerance?patient={Type/}[id]&clinical-status={system|}[code]`

   Example:

   1. GET [base]/AllergyIntolerance?patient=[id]&clinical-status=http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical|active

   Implementation Notes: Fetches a bundle of all AllergyIntolerance 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. (how to search by reference and how to search by token)