CH Core (R4)
5.0.0-ci-build - ci-build Switzerland flag

CH Core (R4), published by HL7 Switzerland. This guide is not an authorized publication; it is the continuous build for version 5.0.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7ch/ch-core/ and changes regularly. See the Directory of published versions

Resource Profile: CHCoreAllergyIntolerance - Detailed Descriptions

Active as of 2024-05-17

Definitions for the ch-core-allergyintolerance resource profile.

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

0. AllergyIntolerance
2. AllergyIntolerance.code
BindingThe codes SHOULD be taken from CH AllergyIntolerance
(preferred to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceValueSet)
4. AllergyIntolerance.patient
TypeReference(CH Core Patient)
6. AllergyIntolerance.recorder
TypeReference(CH Core Practitioner, CH Core PractitionerRole, CH Core Patient, RelatedPerson)
8. AllergyIntolerance.asserter
TypeReference(CH Core Practitioner, CH Core PractitionerRole, CH Core Patient, RelatedPerson)
10. AllergyIntolerance.reaction
12. AllergyIntolerance.reaction.extension
SlicingThis element introduces a set of slices on AllergyIntolerance.reaction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 14. AllergyIntolerance.reaction.extension:certainty
    Slice Namecertainty
    Control0..1
    TypeExtension(AllergyIntolerance Certainty) (Extension Type: CodeableConcept)
    16. AllergyIntolerance.reaction.extension:duration
    Slice Nameduration
    Control0..1
    TypeExtension(AllergyIntolerance Duration) (Extension Type: Duration)
    18. AllergyIntolerance.reaction.extension:location
    Slice Namelocation
    Control0..1
    TypeExtension(AllergyIntolerance Location) (Extension Type: CodeableConcept)
    20. AllergyIntolerance.reaction.extension:exposureDate
    Slice NameexposureDate
    Control0..1
    TypeExtension(AllergyIntolerance Exposure Date) (Extension Type: dateTime)
    22. AllergyIntolerance.reaction.extension:exposureDuration
    Slice NameexposureDuration
    Control0..1
    TypeExtension(AllergyIntolerance Exposure Duration) (Extension Type: Duration)
    24. AllergyIntolerance.reaction.extension:exposureDescription
    Slice NameexposureDescription
    Control0..1
    TypeExtension(AllergyIntolerance ExposureDescription) (Extension Type: string)
    26. AllergyIntolerance.reaction.extension:management
    Slice Namemanagement
    Control0..1
    TypeExtension(AllergyIntolerance Management) (Extension Type: string)
    28. AllergyIntolerance.reaction.substance
    BindingThe codes SHOULD be taken from CH AllergyIntolerance Reaction Substance
    (preferred to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionSubstanceValueSet)
    30. AllergyIntolerance.reaction.manifestation
    BindingThe codes SHOULD be taken from CH AllergyIntolerance Reaction Manifestation
    (preferred to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionManifestationValueSet)

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

    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
    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.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())
    6. AllergyIntolerance.clinicalStatus
    Definition

    The clinical status of the allergy or intolerance.

    Shortactive | 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
    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()))
    8. AllergyIntolerance.verificationStatus
    Definition

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

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

    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
    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()))
    10. 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.

    Control0..1
    BindingThe codes SHOULD be taken from For example codes, see CH AllergyIntolerancehttp://hl7.org/fhir/ValueSet/allergyintolerance-code
    (preferred to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceValueSet)
    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Alternate NamesCode
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. AllergyIntolerance.patient
    Definition

    The patient who has the allergy or intolerance.

    ShortWho the sensitivity is for
    Control1..1
    TypeReference(CH Core Patient, Patient)
    Is Modifierfalse
    Summarytrue
    Alternate NamesPatient
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. AllergyIntolerance.recorder
    Definition

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

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

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

    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
    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

    May be used to represent additional information that is not part of the basic definition of the resource. 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())
    16. 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())
    18. 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()))
    20. AllergyIntolerance.clinicalStatus
    Definition

    The clinical status of the allergy or intolerance.

    Shortactive | 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 AllergyIntoleranceClinicalStatusCodes
    (required to http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1)

    The clinical status of the allergy or intolerance.

    TypeCodeableConcept
    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()))
    22. AllergyIntolerance.verificationStatus
    Definition

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

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

    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 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
    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()))
    24. AllergyIntolerance.type
    Definition

    Identification of the underlying physiological mechanism for the reaction risk.

    Shortallergy | 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 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
    Summarytrue
    Alternate NamesCategory, Class
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. 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()))
    28. AllergyIntolerance.criticality
    Definition

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

    Shortlow | 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 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()))
    30. 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.

    Control0..1
    BindingThe codes SHOULD be taken from CH AllergyIntolerance
    (preferred to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceValueSet)
    TypeCodeableConcept
    Is Modifierfalse
    Summarytrue
    Alternate NamesCode
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. AllergyIntolerance.patient
    Definition

    The patient who has the allergy or intolerance.

    ShortWho the sensitivity is for
    Control1..1
    TypeReference(CH Core Patient)
    Is Modifierfalse
    Summarytrue
    Alternate NamesPatient
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. 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()))
    36. 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] NoteSee Choice of Data Types for 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()))
    38. 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()))
    40. AllergyIntolerance.recorder
    Definition

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

    ShortWho recorded the sensitivity
    Control0..1
    TypeReference(CH Core Practitioner, CH Core PractitionerRole, CH Core Patient, RelatedPerson)
    Is Modifierfalse
    Summaryfalse
    Alternate NamesAuthor
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    42. 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(CH Core Practitioner, CH Core PractitionerRole, CH Core Patient, RelatedPerson)
    Is Modifierfalse
    Summarytrue
    Alternate NamesSource, Informant
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. 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()))
    46. 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()))
    48. 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
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. 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
    52. AllergyIntolerance.reaction.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.reaction.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 54. AllergyIntolerance.reaction.extension:certainty
      Slice Namecertainty
      Definition

      Statement about the degree of clinical certainty that the specific substance was the cause of the manifestation in this reaction event.

      ShortCertainty that the substance was the cause of the manifestation
      Comments

      When certainty is missing, it means no information exists (although it could be in narrative). By contrast, the unknown code is used when there is an explicit assertion that certainty is not known, such as when a patient eats a meal and it is unknown which food caused the reaction.

      Control0..1
      TypeExtension(AllergyIntolerance Certainty) (Extension Type: CodeableConcept)
      Is Modifierfalse
      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())
      56. AllergyIntolerance.reaction.extension:duration
      Slice Nameduration
      Definition

      The amount of time that the Adverse Reaction persisted.

      ShortHow long Manifestations persisted
      Control0..1
      TypeExtension(AllergyIntolerance Duration) (Extension Type: Duration)
      Is Modifierfalse
      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())
      58. AllergyIntolerance.reaction.extension:location
      Slice Namelocation
      Definition

      The anatomical location / body site(s) where the symptoms manifested.

      ShortBody site of manifestations
      Control0..1
      TypeExtension(AllergyIntolerance Location) (Extension Type: CodeableConcept)
      Is Modifierfalse
      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())
      60. AllergyIntolerance.reaction.extension:exposureDate
      Slice NameexposureDate
      Definition

      Record of the date and/or time of the first exposure to the Substance for this Reaction Event.

      ShortDate(/time) of first exposure to Substance
      Comments

      Exposure can be more complicated by more than one exposure events leading to a reaction. Further details about the nature of the exposure can be provided in additional extensions, or as text in the Exposure Description extension.

      Control0..1
      TypeExtension(AllergyIntolerance Exposure Date) (Extension Type: dateTime)
      Is Modifierfalse
      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())
      62. AllergyIntolerance.reaction.extension:exposureDuration
      Slice NameexposureDuration
      Definition

      The amount of time the individual was exposed to the Substance.

      ShortAmount of time individual was exposed to Substance
      Control0..1
      TypeExtension(AllergyIntolerance Exposure Duration) (Extension Type: Duration)
      Is Modifierfalse
      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())
      64. AllergyIntolerance.reaction.extension:exposureDescription
      Slice NameexposureDescription
      Definition

      Text description about exposure to the Substance.

      ShortText description about exposure to the Substance
      Control0..1
      TypeExtension(AllergyIntolerance ExposureDescription) (Extension Type: string)
      Is Modifierfalse
      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())
      66. AllergyIntolerance.reaction.extension:management
      Slice Namemanagement
      Definition

      Text description about the clinical management provided.

      ShortClinical Management Description
      Control0..1
      TypeExtension(AllergyIntolerance Management) (Extension Type: string)
      Is Modifierfalse
      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())
      68. 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())
      70. 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 CH AllergyIntolerance Reaction Substance
      (preferred to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionSubstanceValueSet)
      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      72. 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 CH AllergyIntolerance Reaction Manifestation
      (preferred to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionManifestationValueSet)
      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      Alternate NamesSymptoms, Signs
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      74. 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()))
      76. 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()))
      78. AllergyIntolerance.reaction.severity
      Definition

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

      Shortmild | 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 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
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      80. 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()))
      82. 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()))