US Core Implementation Guide
​9.0.0-ballot - United States of America flag

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 9.0.0-ballot 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: 9.0.0-ballot
Standards status: Trial-use Active as of 2023-10-17 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:

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

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

  • * 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"

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 8.0.0:

  • No changes

    • Formal Views of Profile Content

    Description Differentials, Snapshots, and other representations.

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. 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 ?!SΣC 0..1 CodeableConcept active | inactive | resolved
    Binding: AllergyIntoleranceClinicalStatusCodes (required)
    ... verificationStatus ?!SΣC 0..1 CodeableConcept unconfirmed | confirmed | refuted | entered-in-error
    Binding: AllergyIntoleranceVerificationStatusCodes (required)
    ... code SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
    Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
    ... patient SΣ 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)

    doco 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 v0.23
    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()

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. 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)

    doco 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 v0.23
    AllergyIntolerance.reaction.​manifestation Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. 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 BindingsPurpose
    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 ?!SΣC 0..1 CodeableConcept active | inactive | resolved
    Binding: AllergyIntoleranceClinicalStatusCodes (required)
    ... verificationStatus ?!SΣC 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 SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
    Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
    ... patient SΣ 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

    doco 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 v0.23
    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()

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. 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 ?!SΣC 0..1 CodeableConcept active | inactive | resolved
    Binding: AllergyIntoleranceClinicalStatusCodes (required)
    ... verificationStatus ?!SΣC 0..1 CodeableConcept unconfirmed | confirmed | refuted | entered-in-error
    Binding: AllergyIntoleranceVerificationStatusCodes (required)
    ... code SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
    Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
    ... patient SΣ 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)

    doco 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 v0.23
    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

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. 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)

    doco 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 v0.23
    AllergyIntolerance.reaction.​manifestation Base extensible SNOMED CT Clinical Findings 📦4.0.1 FHIR Std.

    Snapshot ViewView

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. 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 BindingsPurpose
    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 ?!SΣC 0..1 CodeableConcept active | inactive | resolved
    Binding: AllergyIntoleranceClinicalStatusCodes (required)
    ... verificationStatus ?!SΣC 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 SΣ 1..1 CodeableConcept Code that identifies the allergy or intolerance
    Binding: Common substances for allergy and intolerance documentation including refutations . (extensible)
    ... patient SΣ 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

    doco 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 v0.23
    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()

     

    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 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.

    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)