HL7 Europe Patient Summary
0.0.1-ci - ci-build 150

HL7 Europe Patient Summary, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 0.0.1-ci built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/eps/ and changes regularly. See the Directory of published versions

Resource Profile: AllergyIntoleranceEuEps - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the allergyIntolerance-eu-eps resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. AllergyIntolerance
Definition

Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.

ShortAllergy or Intolerance (generally: Risk of adverse reaction to a substance)
Comments

Substances include, but are not limited to: a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.

Control0..*
Is Modifierfalse
Impose ProfileThis profile also requires that the instance also conform this additional profile:
Summaryfalse
Alternate NamesAllergy, Intolerance, Adverse Reaction
Invariantsait-1: 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: 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: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
ait-1: 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: 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())
2. AllergyIntolerance.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. AllergyIntolerance.extension:abatement
Slice Nameabatement
Definition

The date or estimated date that the allergy or intolerance resolved. This is called abatement because of the many overloaded connotations associated with resolution.

ShortWhen the allergy or intolerance resolved
Comments

Age is generally used when the patient reports an age at which the allergy or intolerance abated. If there is no abatement element, the clinicalStatus can be used to convey whether allergy or intolerance has resolved or not. When abatementString exists, it conveys that the allergy or intolerance is abated.

Control0..1
TypeExtension(Abatement) (Extension Type: Choice of: dateTime, Age, Period, Range, string)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. AllergyIntolerance.extension:abatement.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..0*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on AllergyIntolerance.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. AllergyIntolerance.extension:abatement.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

    Control1..1
    Typeuri
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/allergyintolerance-abatement
    10. AllergyIntolerance.extension:abatement.value[x]
    Definition

    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

    ShortValue of extension
    Control10..1
    This element is affected by the following invariants: ext-1
    TypeChoice of: dateTime, Age, Period, Range, string, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Duration, canonical, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, code, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on AllergyIntolerance.extension.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 12. AllergyIntolerance.extension:abatement.value[x]:valueDateTime
      Slice NamevalueDateTime
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortEnd dateValue of extension
      Control0..1
      This element is affected by the following invariants: ext-1
      TypedateTime, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      14. AllergyIntolerance.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. AllergyIntolerance.clinicalStatus
      Definition

      The clinical status of the allergy or intolerance.

      ShortCurrent allergy or Intolerance statusactive | inactive | resolved
      Comments

      Refer to discussion if clincalStatus is missing data. The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

      Control0..1
      This element is affected by the following invariants: ait-1, ait-2
      BindingThe codes SHALL be taken from AllergyIntoleranceClinicalStatusCodeshttp://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1
      (required to http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1)

      The clinical status of the allergy or intolerance.

      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifiertrue because This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as no longer active.
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. AllergyIntolerance.verificationStatus
      Definition

      Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).

      ShortCertaintyunconfirmed | confirmed | refuted | entered-in-error
      Comments

      In the scope of the IPS the entered-in-error concept is not allowed.


      The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

      Control0..1
      This element is affected by the following invariants: ait-1, ait-2
      BindingThe codes SHALL be taken from AllergyIntoleranceVerificationStatusCodeshttp://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1
      (required to http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1)

      Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.

      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifiertrue because This element is labeled as a modifier because the status contains the codes refuted and entered-in-error that mark the AllergyIntolerance as not currently valid.
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. AllergyIntolerance.type
      Definition

      Identification of the underlying physiological mechanism for the reaction risk.

      ShortType of propensityallergy | intolerance - Underlying mechanism (if known)
      Comments

      Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians might not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts might not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource.

      Control0..1
      BindingThe codes SHALL be taken from AllergyIntoleranceTypehttp://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1
      (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1)

      Identification of the underlying physiological mechanism for a Reaction Risk.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Obligations
        ObligationsActor
        SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
        SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
        SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
        Summarytrue
        Alternate NamesCategory, Class
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. AllergyIntolerance.criticality
        Definition

        Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance.

        ShortCriticalitylow | high | unable-to-assess
        Comments

        The default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). Systems that capture a severity at the condition level are actually representing the concept of criticality whereas the severity documented at the reaction level is representing the true reaction severity. Existing systems that are capturing both condition criticality and reaction severity may use the term "severity" to represent both. Criticality is the worst it could be in the future (i.e. situation-agnostic) whereas severity is situation-dependent.

        Control0..1
        BindingThe codes SHALL be taken from AllergyIntoleranceCriticalityhttp://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1
        (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1)

        Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Alternate NamesSeverity, Seriousness, Contra-indication, Risk
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. AllergyIntolerance.code
        Definition

        Code for an allergy or intolerance statement (either a positive or a negated/excluded statement). This may be a code for a substance or pharmaceutical product that is considered to be responsible for the adverse reaction risk (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a negated/excluded code for a specific substance or class (e.g., "No latex allergy") or a general or categorical negated statement (e.g., "No known allergy", "No known drug allergies"). Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk, but it must be consistent with it. For instance, it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'. If a receiving system is unable to confirm that AllergyIntolerance.reaction.substance falls within the semantic scope of AllergyIntolerance.code, then the receiving system should ignore AllergyIntolerance.reaction.substance.

        ShortCode that identifies the allergy or intolerance
        Comments

        It is strongly recommended that this element be populated using a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNII, and ATC. Plain text should only be used if there is no appropriate terminology available. Additional details can be specified in the text.

        When a substance or product code is specified for the 'code' element, the "default" semantic context is that this is a positive statement of an allergy or intolerance (depending on the value of the 'type' element, if present) condition to the specified substance/product. In the corresponding SNOMED CT allergy model, the specified substance/product is the target (destination) of the "Causative agent" relationship.

        The 'substanceExposureRisk' extension is available as a structured and more flexible alternative to the 'code' element for making positive or negative allergy or intolerance statements. This extension provides the capability to make "no known allergy" (or "no risk of adverse reaction") statements regarding any coded substance/product (including cases when a pre-coordinated "no allergy to x" concept for that substance/product does not exist). If the 'substanceExposureRisk' extension is present, the AllergyIntolerance.code element SHALL be omitted.

        Control10..1
        BindingThe codes SHOULD be taken from For example codes, see Allergy Intolerance - IPShttp://hl7.org/fhir/ValueSet/allergyintolerance-code
        (preferred to http://hl7.org/fhir/uv/ips/ValueSet/allergy-intolerance-uv-ips)

        Type of the substance/product, allergy or intolerance condition or a code for absent/unknown allergy.


        Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.

        TypeCodeableConcept(Codeable Concept (IPS))
        Is Modifierfalse
        Must Supporttrue
        Obligations
          ObligationsActor
          SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
          SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
          SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
          Summarytrue
          Alternate NamesCode
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          26. AllergyIntolerance.patient
          Definition

          The patient who has the allergy or intolerance.

          ShortWho the sensitivity is for
          Control1..1
          TypeReference(Patient (EPS), Patient)
          Is Modifierfalse
          Must Supporttrue
          Obligations
            ObligationsActor
            SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
            SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
            SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
            Summarytrue
            Alternate NamesPatient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. AllergyIntolerance.patient.reference
            Definition

            A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

            ShortLiteral reference, Relative, internal or absolute URL
            Comments

            Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

            Control10..1
            This element is affected by the following invariants: ref-1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Obligations
              ObligationsActor
              SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
              SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
              SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. AllergyIntolerance.onset[x]
              Definition

              Estimated or actual date, date-time, or age when allergy or intolerance was identified.

              ShortWhen allergy or intolerance was identified
              Control0..1
              TypeChoice of: dateTime, Age, Period, Range, string
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Obligations
                ObligationsActor
                SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on AllergyIntolerance.onset[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                • type @ $this
                • 32. AllergyIntolerance.onset[x]:onsetDateTime
                  Slice NameonsetDateTime
                  Definition

                  Estimated or actual date, date-time, or age when allergy or intolerance was identified.

                  ShortOnset dateWhen allergy or intolerance was identified
                  Control0..1
                  TypedateTime, string, Period, Range, Age
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Obligations
                    ObligationsActor
                    SHOULD:able-to-populateProducer (IPS)from AllergyIntolerance (IPS)
                    SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                    SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    34. AllergyIntolerance.reaction
                    Definition

                    Details about each adverse reaction event linked to exposure to the identified substance.

                    ShortAdverse Reaction Events linked to exposure to substance
                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    Obligations
                      ObligationsActor
                      SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                      SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                      SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      36. AllergyIntolerance.reaction.modifierExtension
                      Definition

                      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                      ShortExtensions that cannot be ignored even if unrecognized
                      Comments

                      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      Requirements

                      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                      Alternate Namesextensions, user content, modifiers
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                      38. AllergyIntolerance.reaction.substance
                      Definition

                      Identification of the specific substance (or pharmaceutical product) considered to be responsible for the Adverse Reaction event. Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk, but it must be consistent with it. For instance, it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'. If a receiving system is unable to confirm that AllergyIntolerance.reaction.substance falls within the semantic scope of AllergyIntolerance.code, then the receiving system should ignore AllergyIntolerance.reaction.substance.

                      ShortSpecific substance or pharmaceutical product considered to be responsible for event
                      Comments

                      Coding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, "penicillins"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, "amoxycillin"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'.

                      Control0..1
                      BindingThe codes SHOULD be taken from For example codes, see Allergens Value Sethttp://hl7.org/fhir/ValueSet/substance-code
                      (preferred to http://hl7.eu/fhir/hdr/ValueSet/allergens-eu-hdr)
                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      40. AllergyIntolerance.reaction.manifestation
                      Definition

                      Clinical symptoms and/or signs that are observed or associated with the adverse reaction event.

                      ShortClinical symptoms/signs associated with the Event
                      Comments

                      Manifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.

                      Control1..*
                      BindingThe codes SHOULD be taken from For example codes, see Allergy Reaction - IPShttp://hl7.org/fhir/ValueSet/clinical-findings
                      (preferred to http://hl7.org/fhir/uv/ips/ValueSet/allergy-reaction-uv-ips)

                      Type of allergy or intolerance reaction expected to be used in MyHealth@EU


                      Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.

                      TypeCodeableConcept(Codeable Concept (IPS))
                      Is Modifierfalse
                      Must Supporttrue
                      Obligations
                        ObligationsActor
                        SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                        SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                        SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                        Summaryfalse
                        Alternate NamesSymptoms, Signs
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        42. AllergyIntolerance.reaction.severity
                        Definition

                        Clinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations.

                        ShortReaction severitymild | moderate | severe (of event as a whole)
                        Comments

                        It is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions.

                        Control0..1
                        BindingThe codes SHALL be taken from AllergyIntoleranceSeverityhttp://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1
                        (required to http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1)

                        Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.

                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supporttrue
                        Obligations
                          ObligationsActor
                          SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                          SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                          SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

                          Guidance on how to interpret the contents of this table can be foundhere

                          0. AllergyIntolerance
                          Impose ProfileThis profile also requires that the instance also conform this additional profile:
                          2. AllergyIntolerance.extension:abatement
                          Slice Nameabatement
                          4. AllergyIntolerance.extension:abatement.value[x]
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          SlicingThis element introduces a set of slices on AllergyIntolerance.extension.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • type @ $this
                          • 6. AllergyIntolerance.extension:abatement.value[x]:valueDateTime
                            Slice NamevalueDateTime
                            ShortEnd date
                            Control0..1
                            TypedateTime
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            8. AllergyIntolerance.clinicalStatus
                            ShortCurrent allergy or Intolerance status
                            10. AllergyIntolerance.verificationStatus
                            ShortCertainty
                            12. AllergyIntolerance.type
                            ShortType of propensity
                            14. AllergyIntolerance.criticality
                            ShortCriticality
                            16. AllergyIntolerance.code
                            BindingThe codes SHOULD be taken from Allergy Intolerance - IPS
                            (preferred to http://hl7.org/fhir/uv/ips/ValueSet/allergy-intolerance-uv-ips)

                            Type of the substance/product, allergy or intolerance condition or a code for absent/unknown allergy.

                            18. AllergyIntolerance.patient
                            TypeReference(Patient (EPS))
                            20. AllergyIntolerance.onset[x]:onsetDateTime
                            Slice NameonsetDateTime
                            ShortOnset date
                            TypedateTime
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            22. AllergyIntolerance.reaction
                            24. AllergyIntolerance.reaction.substance
                            BindingThe codes SHOULD be taken from Allergens Value Set
                            (preferred to http://hl7.eu/fhir/hdr/ValueSet/allergens-eu-hdr)
                            26. AllergyIntolerance.reaction.manifestation
                            BindingThe codes SHOULD be taken from Allergy Reaction - IPS
                            (preferred to http://hl7.org/fhir/uv/ips/ValueSet/allergy-reaction-uv-ips)

                            Type of allergy or intolerance reaction expected to be used in MyHealth@EU

                            28. AllergyIntolerance.reaction.severity
                            ShortReaction severity

                            Guidance on how to interpret the contents of this table can be foundhere

                            0. AllergyIntolerance
                            Definition

                            Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.

                            ShortAllergy or Intolerance (generally: Risk of adverse reaction to a substance)
                            Comments

                            Substances include, but are not limited to: a therapeutic substance administered correctly at an appropriate dosage for the individual; food; material derived from plants or animals; or venom from insect stings.

                            Control0..*
                            Is Modifierfalse
                            Impose ProfileThis profile also requires that the instance also conform this additional profile:
                            Summaryfalse
                            Alternate NamesAllergy, Intolerance, Adverse Reaction
                            Invariantsait-1: 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: 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: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
                            dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
                            dom-6: A resource should have narrative for robust management (text.`div`.exists())
                            2. AllergyIntolerance.id
                            Definition

                            The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

                            ShortLogical id of this artifact
                            Comments

                            The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

                            Control0..1
                            Typeid
                            Is Modifierfalse
                            Summarytrue
                            4. AllergyIntolerance.meta
                            Definition

                            The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

                            ShortMetadata about the resource
                            Control0..1
                            TypeMeta
                            Is Modifierfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            6. AllergyIntolerance.implicitRules
                            Definition

                            A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

                            ShortA set of rules under which this content was created
                            Comments

                            Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

                            Control0..1
                            Typeuri
                            Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            8. AllergyIntolerance.language
                            Definition

                            The base language in which the resource is written.

                            ShortLanguage of the resource content
                            Comments

                            Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

                            Control0..1
                            BindingThe codes SHOULD be taken from CommonLanguages
                            (preferred to http://hl7.org/fhir/ValueSet/languages)

                            A human language.

                            Additional BindingsPurpose
                            AllLanguagesMax Binding
                            Typecode
                            Is Modifierfalse
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            10. AllergyIntolerance.text
                            Definition

                            A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

                            ShortText summary of the resource, for human interpretation
                            Comments

                            Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

                            Control0..1
                            TypeNarrative
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesnarrative, html, xhtml, display
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            12. AllergyIntolerance.contained
                            Definition

                            These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

                            ShortContained, inline Resources
                            Comments

                            This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

                            Control0..*
                            TypeResource
                            Is Modifierfalse
                            Summaryfalse
                            Alternate Namesinline resources, anonymous resources, contained resources
                            14. AllergyIntolerance.extension
                            Definition

                            An Extension

                            ShortExtension
                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on AllergyIntolerance.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 16. AllergyIntolerance.extension:abatement
                              Slice Nameabatement
                              Definition

                              The date or estimated date that the allergy or intolerance resolved. This is called abatement because of the many overloaded connotations associated with resolution.

                              ShortWhen the allergy or intolerance resolved
                              Comments

                              Age is generally used when the patient reports an age at which the allergy or intolerance abated. If there is no abatement element, the clinicalStatus can be used to convey whether allergy or intolerance has resolved or not. When abatementString exists, it conveys that the allergy or intolerance is abated.

                              Control0..1
                              TypeExtension(Abatement) (Extension Type: Choice of: dateTime, Age, Period, Range, string)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              18. AllergyIntolerance.extension:abatement.id
                              Definition

                              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                              ShortUnique id for inter-element referencing
                              Control0..1
                              This element is affected by the following invariants: ele-1
                              Typeid
                              Is Modifierfalse
                              XML FormatIn the XML format, this property is represented as an attribute.
                              Summaryfalse
                              20. AllergyIntolerance.extension:abatement.extension
                              Definition

                              An Extension

                              ShortExtension
                              Control0..0
                              TypeExtension
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              SlicingThis element introduces a set of slices on AllergyIntolerance.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 22. AllergyIntolerance.extension:abatement.url
                                Definition

                                Source of the definition for the extension code - a logical name or a URL.

                                Shortidentifies the meaning of the extension
                                Comments

                                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                                Control1..1
                                Typeuri
                                Is Modifierfalse
                                XML FormatIn the XML format, this property is represented as an attribute.
                                Summaryfalse
                                Fixed Valuehttp://hl7.org/fhir/StructureDefinition/allergyintolerance-abatement
                                24. AllergyIntolerance.extension:abatement.value[x]
                                Definition

                                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                ShortValue of extension
                                Control1..1
                                This element is affected by the following invariants: ext-1
                                TypeChoice of: dateTime, Age, Period, Range, string
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                Is Modifierfalse
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Summaryfalse
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                SlicingThis element introduces a set of slices on AllergyIntolerance.extension.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                • type @ $this
                                • 26. AllergyIntolerance.extension:abatement.value[x]:valueDateTime
                                  Slice NamevalueDateTime
                                  Definition

                                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                                  ShortEnd date
                                  Control0..1
                                  This element is affected by the following invariants: ext-1
                                  TypedateTime
                                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Summaryfalse
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  28. AllergyIntolerance.modifierExtension
                                  Definition

                                  May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                  ShortExtensions that cannot be ignored
                                  Comments

                                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                  Control0..*
                                  TypeExtension
                                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                                  Summaryfalse
                                  Requirements

                                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                  Alternate Namesextensions, user content
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                  30. AllergyIntolerance.identifier
                                  Definition

                                  Business identifiers assigned to this AllergyIntolerance by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

                                  ShortExternal ids for this item
                                  Comments

                                  This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

                                  NoteThis is a business identifier, not a resource identifier (see discussion)
                                  Control0..*
                                  TypeIdentifier
                                  Is Modifierfalse
                                  Summarytrue
                                  Requirements

                                  Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers.

                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  32. AllergyIntolerance.clinicalStatus
                                  Definition

                                  The clinical status of the allergy or intolerance.

                                  ShortCurrent allergy or Intolerance status
                                  Comments

                                  Refer to discussion if clincalStatus is missing data. The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

                                  Control0..1
                                  This element is affected by the following invariants: ait-1, ait-2
                                  BindingThe codes SHALL be taken from AllergyIntoleranceClinicalStatusCodes
                                  (required to http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1)

                                  The clinical status of the allergy or intolerance.

                                  TypeCodeableConcept(Codeable Concept (IPS))
                                  Is Modifiertrue because This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as no longer active.
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  34. AllergyIntolerance.verificationStatus
                                  Definition

                                  Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).

                                  ShortCertainty
                                  Comments

                                  In the scope of the IPS the entered-in-error concept is not allowed.

                                  Control0..1
                                  This element is affected by the following invariants: ait-1, ait-2
                                  BindingThe codes SHALL be taken from AllergyIntoleranceVerificationStatusCodes
                                  (required to http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1)

                                  Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.

                                  TypeCodeableConcept(Codeable Concept (IPS))
                                  Is Modifiertrue because This element is labeled as a modifier because the status contains the codes refuted and entered-in-error that mark the AllergyIntolerance as not currently valid.
                                  Summarytrue
                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                  36. AllergyIntolerance.type
                                  Definition

                                  Identification of the underlying physiological mechanism for the reaction risk.

                                  ShortType of propensity
                                  Comments

                                  Allergic (typically immune-mediated) reactions have been traditionally regarded as an indicator for potential escalation to significant future risk. Contemporary knowledge suggests that some reactions previously thought to be immune-mediated are, in fact, non-immune, but in some cases can still pose a life threatening risk. It is acknowledged that many clinicians might not be in a position to distinguish the mechanism of a particular reaction. Often the term "allergy" is used rather generically and may overlap with the use of "intolerance" - in practice the boundaries between these two concepts might not be well-defined or understood. This data element is included nevertheless, because many legacy systems have captured this attribute. Immunologic testing may provide supporting evidence for the basis of the reaction and the causative substance, but no tests are 100% sensitive or specific for sensitivity to a particular substance. If, as is commonly the case, it is unclear whether the reaction is due to an allergy or an intolerance, then the type element should be omitted from the resource.

                                  Control0..1
                                  BindingThe codes SHALL be taken from AllergyIntoleranceType
                                  (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1)

                                  Identification of the underlying physiological mechanism for a Reaction Risk.

                                  Typecode
                                  Is Modifierfalse
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Must Supporttrue
                                  Obligations
                                    ObligationsActor
                                    SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                                    SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                    SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                    Summarytrue
                                    Alternate NamesCategory, Class
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    38. AllergyIntolerance.category
                                    Definition

                                    Category of the identified substance.

                                    Shortfood | medication | environment | biologic
                                    Comments

                                    This data element has been included because it is currently being captured in some clinical systems. This data can be derived from the substance where coding systems are used, and is effectively redundant in that situation. When searching on category, consider the implications of AllergyIntolerance resources without a category. For example, when searching on category = medication, medication allergies that don't have a category valued will not be returned. Refer to search for more information on how to search category with a :missing modifier to get allergies that don't have a category. Additionally, category should be used with caution because category can be subjective based on the sender.

                                    Control0..*
                                    BindingThe codes SHALL be taken from AllergyIntoleranceCategory
                                    (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1)

                                    Category of an identified substance associated with allergies or intolerances.

                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Alternate NamesCategory, Type, Reaction Type, Class
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    40. AllergyIntolerance.criticality
                                    Definition

                                    Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance.

                                    ShortCriticality
                                    Comments

                                    The default criticality value for any propensity to an adverse reaction should be 'Low Risk', indicating at the very least a relative contraindication to deliberate or voluntary exposure to the substance. 'High Risk' is flagged if the clinician has identified a propensity for a more serious or potentially life-threatening reaction, such as anaphylaxis, and implies an absolute contraindication to deliberate or voluntary exposure to the substance. If this element is missing, the criticality is unknown (though it may be known elsewhere). Systems that capture a severity at the condition level are actually representing the concept of criticality whereas the severity documented at the reaction level is representing the true reaction severity. Existing systems that are capturing both condition criticality and reaction severity may use the term "severity" to represent both. Criticality is the worst it could be in the future (i.e. situation-agnostic) whereas severity is situation-dependent.

                                    Control0..1
                                    BindingThe codes SHALL be taken from AllergyIntoleranceCriticality
                                    (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1)

                                    Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.

                                    Typecode
                                    Is Modifierfalse
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Summarytrue
                                    Alternate NamesSeverity, Seriousness, Contra-indication, Risk
                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                    42. AllergyIntolerance.code
                                    Definition

                                    Code for an allergy or intolerance statement (either a positive or a negated/excluded statement). This may be a code for a substance or pharmaceutical product that is considered to be responsible for the adverse reaction risk (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a negated/excluded code for a specific substance or class (e.g., "No latex allergy") or a general or categorical negated statement (e.g., "No known allergy", "No known drug allergies"). Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk, but it must be consistent with it. For instance, it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'. If a receiving system is unable to confirm that AllergyIntolerance.reaction.substance falls within the semantic scope of AllergyIntolerance.code, then the receiving system should ignore AllergyIntolerance.reaction.substance.

                                    ShortCode that identifies the allergy or intolerance
                                    Comments

                                    It is strongly recommended that this element be populated using a terminology, where possible. For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10, UNII, and ATC. Plain text should only be used if there is no appropriate terminology available. Additional details can be specified in the text.

                                    When a substance or product code is specified for the 'code' element, the "default" semantic context is that this is a positive statement of an allergy or intolerance (depending on the value of the 'type' element, if present) condition to the specified substance/product. In the corresponding SNOMED CT allergy model, the specified substance/product is the target (destination) of the "Causative agent" relationship.

                                    The 'substanceExposureRisk' extension is available as a structured and more flexible alternative to the 'code' element for making positive or negative allergy or intolerance statements. This extension provides the capability to make "no known allergy" (or "no risk of adverse reaction") statements regarding any coded substance/product (including cases when a pre-coordinated "no allergy to x" concept for that substance/product does not exist). If the 'substanceExposureRisk' extension is present, the AllergyIntolerance.code element SHALL be omitted.

                                    Control1..1
                                    BindingThe codes SHOULD be taken from Allergy Intolerance - IPS
                                    (preferred to http://hl7.org/fhir/uv/ips/ValueSet/allergy-intolerance-uv-ips)

                                    Type of the substance/product, allergy or intolerance condition or a code for absent/unknown allergy.

                                    TypeCodeableConcept(Codeable Concept (IPS))
                                    Is Modifierfalse
                                    Must Supporttrue
                                    Obligations
                                      ObligationsActor
                                      SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                                      SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                      SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                      Summarytrue
                                      Alternate NamesCode
                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                      44. AllergyIntolerance.patient
                                      Definition

                                      The patient who has the allergy or intolerance.

                                      ShortWho the sensitivity is for
                                      Control1..1
                                      TypeReference(Patient (EPS))
                                      Is Modifierfalse
                                      Must Supporttrue
                                      Obligations
                                        ObligationsActor
                                        SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                                        SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                        SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                        Summarytrue
                                        Alternate NamesPatient
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        46. AllergyIntolerance.patient.id
                                        Definition

                                        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                        ShortUnique id for inter-element referencing
                                        Control0..1
                                        Typestring
                                        Is Modifierfalse
                                        XML FormatIn the XML format, this property is represented as an attribute.
                                        Summaryfalse
                                        48. AllergyIntolerance.patient.extension
                                        Definition

                                        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                        ShortAdditional content defined by implementations
                                        Comments

                                        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                        Control0..*
                                        TypeExtension
                                        Is Modifierfalse
                                        Summaryfalse
                                        Alternate Namesextensions, user content
                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                        SlicingThis element introduces a set of slices on AllergyIntolerance.patient.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                                        • value @ url
                                        • 50. AllergyIntolerance.patient.reference
                                          Definition

                                          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                                          ShortLiteral reference, Relative, internal or absolute URL
                                          Comments

                                          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                                          Control1..1
                                          This element is affected by the following invariants: ref-1
                                          Typestring
                                          Is Modifierfalse
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Must Supporttrue
                                          Obligations
                                            ObligationsActor
                                            SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                                            SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                            SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            52. AllergyIntolerance.patient.type
                                            Definition

                                            The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                                            The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                                            ShortType the reference refers to (e.g. "Patient")
                                            Comments

                                            This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                                            Control0..1
                                            BindingUnless not suitable, these codes SHALL be taken from ResourceType
                                            (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                                            Aa resource (or, for logical models, the URI of the logical model).

                                            Typeuri
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            54. AllergyIntolerance.patient.identifier
                                            Definition

                                            An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                                            ShortLogical reference, when literal reference is not known
                                            Comments

                                            When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                                            When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                                            Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                                            Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                                            NoteThis is a business identifier, not a resource identifier (see discussion)
                                            Control0..1
                                            TypeIdentifier
                                            Is Modifierfalse
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            56. AllergyIntolerance.patient.display
                                            Definition

                                            Plain text narrative that identifies the resource in addition to the resource reference.

                                            ShortText alternative for the resource
                                            Comments

                                            This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                                            Control0..1
                                            Typestring
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Summarytrue
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            58. AllergyIntolerance.encounter
                                            Definition

                                            The encounter when the allergy or intolerance was asserted.

                                            ShortEncounter when the allergy or intolerance was asserted
                                            Control0..1
                                            TypeReference(Encounter)
                                            Is Modifierfalse
                                            Summaryfalse
                                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                            60. AllergyIntolerance.onset[x]
                                            Definition

                                            Estimated or actual date, date-time, or age when allergy or intolerance was identified.

                                            ShortWhen allergy or intolerance was identified
                                            Control0..1
                                            TypeChoice of: dateTime, Age, Period, Range, string
                                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                            Is Modifierfalse
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Must Supporttrue
                                            Must Support TypesNo must-support rules about the choice of types/profiles
                                            Obligations
                                              ObligationsActor
                                              SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                                              SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                              SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                              Summaryfalse
                                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                              SlicingThis element introduces a set of slices on AllergyIntolerance.onset[x]. The slices areUnordered and Closed, and can be differentiated using the following discriminators:
                                              • type @ $this
                                              • 62. AllergyIntolerance.onset[x]:onsetDateTime
                                                Slice NameonsetDateTime
                                                Definition

                                                Estimated or actual date, date-time, or age when allergy or intolerance was identified.

                                                ShortOnset date
                                                Control0..1
                                                TypedateTime
                                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                                Is Modifierfalse
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Must Supporttrue
                                                Obligations
                                                  ObligationsActor
                                                  SHOULD:able-to-populateProducer (IPS)from AllergyIntolerance (IPS)
                                                  SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                                  SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  64. AllergyIntolerance.recordedDate
                                                  Definition

                                                  The recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date.

                                                  ShortDate first version of the resource instance was recorded
                                                  Control0..1
                                                  TypedateTime
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  66. AllergyIntolerance.recorder
                                                  Definition

                                                  Individual who recorded the record and takes responsibility for its content.

                                                  ShortWho recorded the sensitivity
                                                  Control0..1
                                                  TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson)
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Alternate NamesAuthor
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  68. AllergyIntolerance.asserter
                                                  Definition

                                                  The source of the information about the allergy that is recorded.

                                                  ShortSource of the information about the allergy
                                                  Comments

                                                  The recorder takes responsibility for the content, but can reference the source from where they got it.

                                                  Control0..1
                                                  TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole)
                                                  Is Modifierfalse
                                                  Summarytrue
                                                  Alternate NamesSource, Informant
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  70. AllergyIntolerance.lastOccurrence
                                                  Definition

                                                  Represents the date and/or time of the last known occurrence of a reaction event.

                                                  ShortDate(/time) of last known occurrence of a reaction
                                                  Comments

                                                  This date may be replicated by one of the Onset of Reaction dates. Where a textual representation of the date of last occurrence is required e.g. 'In Childhood, '10 years ago' the Comment element should be used.

                                                  Control0..1
                                                  TypedateTime
                                                  Is Modifierfalse
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  72. AllergyIntolerance.note
                                                  Definition

                                                  Additional narrative about the propensity for the Adverse Reaction, not captured in other fields.

                                                  ShortAdditional text not captured in other fields
                                                  Comments

                                                  For example: including reason for flagging a seriousness of 'High Risk'; and instructions related to future exposure or administration of the substance, such as administration within an Intensive Care Unit or under corticosteroid cover. The notes should be related to an allergy or intolerance as a condition in general and not related to any particular episode of it. For episode notes and descriptions, use AllergyIntolerance.event.description and AllergyIntolerance.event.notes.

                                                  Control0..*
                                                  TypeAnnotation
                                                  Is Modifierfalse
                                                  Summaryfalse
                                                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                  74. AllergyIntolerance.reaction
                                                  Definition

                                                  Details about each adverse reaction event linked to exposure to the identified substance.

                                                  ShortAdverse Reaction Events linked to exposure to substance
                                                  Control0..*
                                                  TypeBackboneElement
                                                  Is Modifierfalse
                                                  Must Supporttrue
                                                  Obligations
                                                    ObligationsActor
                                                    SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                                                    SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                                    SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    76. AllergyIntolerance.reaction.id
                                                    Definition

                                                    Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                                                    ShortUnique id for inter-element referencing
                                                    Control0..1
                                                    Typestring
                                                    Is Modifierfalse
                                                    XML FormatIn the XML format, this property is represented as an attribute.
                                                    Summaryfalse
                                                    78. AllergyIntolerance.reaction.extension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                                                    ShortAdditional content defined by implementations
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Alternate Namesextensions, user content
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    80. AllergyIntolerance.reaction.modifierExtension
                                                    Definition

                                                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                                                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                                                    ShortExtensions that cannot be ignored even if unrecognized
                                                    Comments

                                                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                                                    Control0..*
                                                    TypeExtension
                                                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                                                    Summarytrue
                                                    Requirements

                                                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                                                    Alternate Namesextensions, user content, modifiers
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                                                    82. AllergyIntolerance.reaction.substance
                                                    Definition

                                                    Identification of the specific substance (or pharmaceutical product) considered to be responsible for the Adverse Reaction event. Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk, but it must be consistent with it. For instance, it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'. If a receiving system is unable to confirm that AllergyIntolerance.reaction.substance falls within the semantic scope of AllergyIntolerance.code, then the receiving system should ignore AllergyIntolerance.reaction.substance.

                                                    ShortSpecific substance or pharmaceutical product considered to be responsible for event
                                                    Comments

                                                    Coding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, "penicillins"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, "amoxycillin"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'.

                                                    Control0..1
                                                    BindingThe codes SHOULD be taken from Allergens Value Set
                                                    (preferred to http://hl7.eu/fhir/hdr/ValueSet/allergens-eu-hdr)
                                                    TypeCodeableConcept
                                                    Is Modifierfalse
                                                    Summaryfalse
                                                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                    84. AllergyIntolerance.reaction.manifestation
                                                    Definition

                                                    Clinical symptoms and/or signs that are observed or associated with the adverse reaction event.

                                                    ShortClinical symptoms/signs associated with the Event
                                                    Comments

                                                    Manifestation can be expressed as a single word, phrase or brief description. For example: nausea, rash or no reaction. It is preferable that manifestation should be coded with a terminology, where possible. The values entered here may be used to display on an application screen as part of a list of adverse reactions, as recommended in the UK NHS CUI guidelines. Terminologies commonly used include, but are not limited to, SNOMED CT or ICD10.

                                                    Control1..*
                                                    BindingThe codes SHOULD be taken from Allergy Reaction - IPS
                                                    (preferred to http://hl7.org/fhir/uv/ips/ValueSet/allergy-reaction-uv-ips)

                                                    Type of allergy or intolerance reaction expected to be used in MyHealth@EU

                                                    TypeCodeableConcept(Codeable Concept (IPS))
                                                    Is Modifierfalse
                                                    Must Supporttrue
                                                    Obligations
                                                      ObligationsActor
                                                      SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                                                      SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                                      SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                                      Summaryfalse
                                                      Alternate NamesSymptoms, Signs
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      86. AllergyIntolerance.reaction.description
                                                      Definition

                                                      Text description about the reaction as a whole, including details of the manifestation if required.

                                                      ShortDescription of the event as a whole
                                                      Comments

                                                      Use the description to provide any details of a particular event of the occurred reaction such as circumstances, reaction specifics, what happened before/after. Information, related to the event, but not describing a particular care should be captured in the comment field. For example: at the age of four, the patient was given penicillin for strep throat and subsequently developed severe hives.

                                                      Control0..1
                                                      Typestring
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Alternate NamesNarrative, Text
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      88. AllergyIntolerance.reaction.onset
                                                      Definition

                                                      Record of the date and/or time of the onset of the Reaction.

                                                      ShortDate(/time) when manifestations showed
                                                      Control0..1
                                                      TypedateTime
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Summaryfalse
                                                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                      90. AllergyIntolerance.reaction.severity
                                                      Definition

                                                      Clinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations.

                                                      ShortReaction severity
                                                      Comments

                                                      It is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions.

                                                      Control0..1
                                                      BindingThe codes SHALL be taken from AllergyIntoleranceSeverity
                                                      (required to http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1)

                                                      Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.

                                                      Typecode
                                                      Is Modifierfalse
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Must Supporttrue
                                                      Obligations
                                                        ObligationsActor
                                                        SHALL:populate-if-knownProducer (IPS)from AllergyIntolerance (IPS)
                                                        SHALL:handleConsumer (IPS)from AllergyIntolerance (IPS)
                                                        SHOULD:displayConsumer (IPS)from AllergyIntolerance (IPS)
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        92. AllergyIntolerance.reaction.exposureRoute
                                                        Definition

                                                        Identification of the route by which the subject was exposed to the substance.

                                                        ShortHow the subject was exposed to the substance
                                                        Comments

                                                        Coding of the route of exposure with a terminology should be used wherever possible.

                                                        Control0..1
                                                        BindingFor example codes, see SNOMEDCTRouteCodes
                                                        (example to http://hl7.org/fhir/ValueSet/route-codes)

                                                        A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.

                                                        TypeCodeableConcept
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                                        94. AllergyIntolerance.reaction.note
                                                        Definition

                                                        Additional text about the adverse reaction event not captured in other fields.

                                                        ShortText about event not captured in other fields
                                                        Comments

                                                        Use this field to record information indirectly related to a particular event and not captured in the description. For example: Clinical records are no longer available, recorded based on information provided to the patient by her mother and her mother is deceased.

                                                        Control0..*
                                                        TypeAnnotation
                                                        Is Modifierfalse
                                                        Summaryfalse
                                                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))