StructureDefinition UKCore-AllergyIntolerance

Canonical_URLStatusCurrent_VersionLast_UpdatedDescription
https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntoleranceactive2.5.02024-07-11

This profile defines the UK constraints and extensions on the International FHIR resource AllergyIntolerance.


Profile_Purpose

This profile allows a record of a clinical assessment of an allergy or intolerance; a propensity, or a potential risk to an individual, to have an adverse reaction on future exposure to the specified substance, or class of substance.

Where a propensity is identified, to record information or evidence about a reaction event that is characterised by any harmful or undesirable physiological response that is specific to the individual and triggered by exposure of an individual to the identified substance or class of substance.

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.

This resource is used to record physical conditions. It SHALL NOT be used to record preferences for or against types of treatment, for example on religious grounds. For such use cases consider the use of the FHIR Consent resource.

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
evidenceI0..*Extension(Reference(DiagnosticReport))
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
id0..1string
allergyIntoleranceEndI0..1Extension(Complex)
codingΣ0..*Coding
textΣ0..1string
verificationStatusS Σ ?! I0..1CodeableConceptBinding
typeΣ0..1codeBinding
categoryΣ0..*codeBinding
criticalityΣ0..1codeBinding
codeS Σ1..1CodeableConceptBinding
patientS Σ I1..1Reference(Patient)
encounterI0..1Reference(Encounter)
onsetDateTimedateTime
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
recordedDate0..1dateTime
recorderI0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
asserterΣ I0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)
lastOccurrence0..1dateTime
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
substance0..1CodeableConceptBinding
manifestation1..*CodeableConceptBinding
description0..1string
onset0..1dateTime
severityS0..1codeBinding
exposureRoute0..1CodeableConceptBinding
note0..*Annotation

Detailed Descriptions

AllergyIntolerance
DefinitionRisk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.
Cardinality0...*
AliasAllergy, Intolerance, Adverse Reaction
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.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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-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-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • 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()
Mappings
  • rim: Entity. Role, or Act
  • rim: Observation[classCode=OBS, moodCode=EVN]
AllergyIntolerance.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
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.

AllergyIntolerance.meta
DefinitionThe 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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
AllergyIntolerance.implicitRules
DefinitionA 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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
AllergyIntolerance.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
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).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
AllergyIntolerance.text
DefinitionA 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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
AllergyIntolerance.contained
DefinitionThese 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.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained 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.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
AllergyIntolerance.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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()
Mappings
  • rim: n/a
  • rim: N/A
AllergyIntolerance.extension:evidence
DefinitionA reference to results of investigations that confirmed the certainty of the diagnosis.
Cardinality0...*
TypeExtension(Reference(DiagnosticReport))
Aliasextensions, user content
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.

Invariants
  • 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()
Mappings
  • rim: n/a
  • rim: N/A
AllergyIntolerance.modifierExtension
DefinitionMay 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).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
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.

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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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()
Mappings
  • rim: n/a
  • rim: N/A
AllergyIntolerance.identifier
DefinitionBusiness 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.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

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

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: IAM-7
  • rim: id
AllergyIntolerance.clinicalStatus
DefinitionThe clinical status of the allergy or intolerance.
Cardinality0...1
TypeCodeableConcept
Binding

The clinical status of the allergy or intolerance.

AllergyIntoleranceClinicalStatusCodes (required)
Must SupportTrue
ModifierTrue
SummaryTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.status
  • rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
AllergyIntolerance.clinicalStatus.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
AllergyIntolerance.clinicalStatus.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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()
Mappings
  • rim: n/a
  • rim: N/A
AllergyIntolerance.clinicalStatus.extension:allergyIntoleranceEnd
DefinitionSupports the date when the allergy or intolerance was no longer valid, and/or, the reason why the allergy or intolerance is no longer valid.
Cardinality0...1
TypeExtension(Complex)
Aliasextensions, user content
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.

Invariants
  • 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()
Mappings
  • rim: n/a
  • rim: N/A
AllergyIntolerance.clinicalStatus.coding
DefinitionA reference to a code defined by a terminology system.
Cardinality0...*
TypeCoding
SummaryTrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • v2: C*E.1-8, C*E.10-22
  • rim: union(., ./translation)
  • orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
AllergyIntolerance.clinicalStatus.text
DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Cardinality0...1
Typestring
SummaryTrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: C*E.9. But note many systems use C*E.2 for this
  • rim: ./originalText[mediaType/code="text/plain"]/data
  • orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
AllergyIntolerance.verificationStatus
DefinitionAssertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).
Cardinality0...1
TypeCodeableConcept
Binding

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

AllergyIntoleranceVerificationStatusCodes (required)
Must SupportTrue
ModifierTrue
SummaryTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.status
  • rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
AllergyIntolerance.type
DefinitionIdentification of the underlying physiological mechanism for the reaction risk.
Cardinality0...1
Typecode
Binding

Identification of the underlying physiological mechanism for a Reaction Risk.

AllergyIntoleranceType (required)
SummaryTrue
AliasCategory, Class
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.class
  • v2: IAM-9
  • rim: code
AllergyIntolerance.category
DefinitionCategory of the identified substance.
Cardinality0...*
Typecode
Binding

Category of an identified substance associated with allergies or intolerances.

AllergyIntoleranceCategory (required)
SummaryTrue
AliasCategory, Type, Reaction Type, Class
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.class
  • v2: AL1-2
  • rim: value < IntoleranceValue (Agent)
AllergyIntolerance.criticality
DefinitionEstimate of the potential clinical harm, or seriousness, of the reaction to the identified substance.
Cardinality0...1
Typecode
Binding

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

AllergyIntoleranceCriticality (required)
SummaryTrue
AliasSeverity, Seriousness, Contra-indication, Risk
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.grade
  • v2: AL1-4
  • rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]
AllergyIntolerance.code
DefinitionCode 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.
Cardinality1...1
TypeCodeableConcept
Binding

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

UKCoreAllergyCode (preferred)
Must SupportTrue
SummaryTrue
AliasCode
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.what[x]
  • v2: AL1-3 / IAM-3
  • rim: substance/product: .participation[typeCode=CAGNT].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType] negated/excluded substance/product: .participation[typeCode=CAGNT, negationInd=true].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType] positive or negated/excluded condition/situation: Observation.code=ASSERTION; Observation.value
AllergyIntolerance.patient
DefinitionThe patient who has the allergy or intolerance.
Cardinality1...1
TypeReference(Patient)
Must SupportTrue
SummaryTrue
AliasPatient
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.subject[x]
  • v2: (PID-3)
  • rim: .participation[typeCode=SBJ].role[classCode=PAT]
  • w5: FiveWs.subject
AllergyIntolerance.encounter
DefinitionThe encounter when the allergy or intolerance was asserted.
Cardinality0...1
TypeReference(Encounter)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.context
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
AllergyIntolerance.onset[x]
DefinitionEstimated or actual date, date-time, or age when allergy or intolerance was identified.
Cardinality0...1
TypedateTime
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.init
  • rim: effectiveTime.low
AllergyIntolerance.recordedDate
DefinitionThe recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date.
Cardinality0...1
TypedateTime
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.recorded
  • v2: IAM-13
  • rim: .participation[typeCode=AUT].time
AllergyIntolerance.recorder
DefinitionIndividual who recorded the record and takes responsibility for its content.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole | Patient | RelatedPerson)
AliasAuthor
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
AllergyIntolerance.asserter
DefinitionThe source of the information about the allergy that is recorded.
Cardinality0...1
TypeReference(Patient | RelatedPerson | Practitioner | PractitionerRole)
SummaryTrue
AliasSource, Informant
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.source
  • v2: IAM-14 (if patient) / IAM-18 (if practitioner)
  • rim: .participation[typeCode=INF].role
AllergyIntolerance.lastOccurrence
DefinitionRepresents the date and/or time of the last known occurrence of a reaction event.
Cardinality0...1
TypedateTime
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)].effectiveTime
AllergyIntolerance.note
DefinitionAdditional narrative about the propensity for the Adverse Reaction, not captured in other fields.
Cardinality0...*
TypeAnnotation
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • rim: subjectOf.observationEvent[code="annotation"].value
AllergyIntolerance.reaction
DefinitionDetails about each adverse reaction event linked to exposure to the identified substance.
Cardinality0...*
TypeBackboneElement
Must SupportTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)]
AllergyIntolerance.reaction.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
AllergyIntolerance.reaction.extension
DefinitionMay 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.
Cardinality0...*
TypeExtension
Aliasextensions, user content
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.

SlicingUnordered, Open, by url(Value)
Invariants
  • 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()
Mappings
  • rim: n/a
  • rim: N/A
AllergyIntolerance.reaction.modifierExtension
DefinitionMay 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).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
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.

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.

Invariants
  • 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()
Mappings
  • rim: n/a
  • rim: N/A
AllergyIntolerance.reaction.substance
DefinitionIdentification 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.
Cardinality0...1
TypeCodeableConcept
Binding

Codes defining the type of the substance (including pharmaceutical products).

UKCoreAllergySubstance (preferred)
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'.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].participation[typeCode=CSM].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]
AllergyIntolerance.reaction.manifestation
DefinitionClinical symptoms and/or signs that are observed or associated with the adverse reaction event.
Cardinality1...*
TypeCodeableConcept
Binding

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

UKCoreAllergyManifestation (preferred)
AliasSymptoms, Signs
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: AL1-5
  • rim: code
AllergyIntolerance.reaction.description
DefinitionText description about the reaction as a whole, including details of the manifestation if required.
Cardinality0...1
Typestring
AliasNarrative, Text
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: text
AllergyIntolerance.reaction.onset
DefinitionRecord of the date and/or time of the onset of the Reaction.
Cardinality0...1
TypedateTime
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: AL1-6
  • rim: effectiveTime.low
AllergyIntolerance.reaction.severity
DefinitionClinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations.
Cardinality0...1
Typecode
Binding

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

AllergyIntoleranceSeverity (required)
Must SupportTrue
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]
AllergyIntolerance.reaction.exposureRoute
DefinitionIdentification of the route by which the subject was exposed to the substance.
Cardinality0...1
TypeCodeableConcept
Binding

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

UKCoreSubstanceOrProductAdministrationRoute (preferred)
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].routeCode
AllergyIntolerance.reaction.note
DefinitionAdditional text about the adverse reaction event not captured in other fields.
Cardinality0...*
TypeAnnotation
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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • rim: subjectOf.observationEvent[code="annotation"].value

Table View

AllergyIntolerance..
AllergyIntolerance.extensionExtension..
AllergyIntolerance.clinicalStatus..
AllergyIntolerance.clinicalStatus.extensionExtension..
AllergyIntolerance.verificationStatus..
AllergyIntolerance.code1..
AllergyIntolerance.patient..
AllergyIntolerance.reaction..
AllergyIntolerance.reaction.substance..
AllergyIntolerance.reaction.manifestation..
AllergyIntolerance.reaction.severity..
AllergyIntolerance.reaction.exposureRoute..

XML View

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntolerance" />
    <version value="2.5.0" />
    <name value="UKCoreAllergyIntolerance" />
    <title value="UK Core Allergy Intolerance" />
    <status value="active" />
    <date value="2024-07-11" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [AllergyIntolerance](https://hl7.org/fhir/R4/AllergyIntolerance.html)." />
    <purpose value="This profile allows a record of a clinical assessment of an allergy or intolerance; a propensity, or a potential risk to an individual, to have an adverse reaction on future exposure to the specified substance, or class of substance. \n\nWhere a propensity is identified, to record information or evidence about a reaction event that is characterised by any harmful or undesirable physiological response that is specific to the individual and triggered by exposure of an individual to the identified substance or class of substance. \n\nSubstances 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. \n\nThis resource is used to record physical conditions. It SHALL NOT be used to record preferences for or against types of treatment, for example on religious grounds. For such use cases consider the use of the FHIR [Consent](https://hl7.org/fhir/R4/consent.html) resource." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="AllergyIntolerance" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/AllergyIntolerance" />
    <derivation value="constraint" />
    <differential>
        <element id="AllergyIntolerance.extension:evidence">
            <path value="AllergyIntolerance.extension" />
            <sliceName value="evidence" />
            <short value="A reference to a DiagnosticReport resource for investigations that confirm the certainty of the allergy or intolerance diagnosis." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence" />
            </type>
        </element>
        <element id="AllergyIntolerance.clinicalStatus">
            <path value="AllergyIntolerance.clinicalStatus" />
            <short value="Defines whether the allergy or intolerance is active, inactive or resolved." />
            <mustSupport value="true" />
        </element>
        <element id="AllergyIntolerance.clinicalStatus.extension:allergyIntoleranceEnd">
            <path value="AllergyIntolerance.clinicalStatus.extension" />
            <sliceName value="allergyIntoleranceEnd" />
            <short value="The date when the allergy or intolerance clinicalStatus is updated to inactive or resolved." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="AllergyIntolerance.verificationStatus">
            <path value="AllergyIntolerance.verificationStatus" />
            <short value="Defines the assertion of the allergy or intolerance." />
            <mustSupport value="true" />
        </element>
        <element id="AllergyIntolerance.code">
            <path value="AllergyIntolerance.code" />
            <short value="This code identifies the allergy or intolerance." />
            <min value="1" />
            <mustSupport value="true" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode" />
            </binding>
        </element>
        <element id="AllergyIntolerance.patient">
            <path value="AllergyIntolerance.patient" />
            <short value="Links the allergy or intolerance to the patient." />
            <mustSupport value="true" />
        </element>
        <element id="AllergyIntolerance.reaction">
            <path value="AllergyIntolerance.reaction" />
            <short value="Details about each adverse reaction event." />
            <mustSupport value="true" />
        </element>
        <element id="AllergyIntolerance.reaction.substance">
            <path value="AllergyIntolerance.reaction.substance" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-AllergySubstance" />
            </binding>
        </element>
        <element id="AllergyIntolerance.reaction.manifestation">
            <path value="AllergyIntolerance.reaction.manifestation" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation" />
            </binding>
        </element>
        <element id="AllergyIntolerance.reaction.severity">
            <path value="AllergyIntolerance.reaction.severity" />
            <short value="A clinical assessment of the severity of the reaction event as a whole." />
            <mustSupport value="true" />
        </element>
        <element id="AllergyIntolerance.reaction.exposureRoute">
            <path value="AllergyIntolerance.reaction.exposureRoute" />
            <binding>
                <strength value="preferred" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute" />
            </binding>
        </element>
    </differential>
</StructureDefinition>

JSON View

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-AllergyIntolerance",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-AllergyIntolerance",
    "version": "2.5.0",
    "name": "UKCoreAllergyIntolerance",
    "title": "UK Core Allergy Intolerance",
    "status": "active",
    "date": "2024-07-11",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [AllergyIntolerance](https://hl7.org/fhir/R4/AllergyIntolerance.html).",
    "purpose": "This profile allows a record of a clinical assessment of an allergy or intolerance; a propensity, or a potential risk to an individual, to have an adverse reaction on future exposure to the specified substance, or class of substance. \n\nWhere a propensity is identified, to record information or evidence about a reaction event that is characterised by any harmful or undesirable physiological response that is specific to the individual and triggered by exposure of an individual to the identified substance or class of substance. \n\nSubstances 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. \n\nThis resource is used to record physical conditions. It SHALL NOT be used to record preferences for or against types of treatment, for example on religious grounds. For such use cases consider the use of the FHIR [Consent](https://hl7.org/fhir/R4/consent.html) resource.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "AllergyIntolerance",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/AllergyIntolerance",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "AllergyIntolerance.extension:evidence",
                "path": "AllergyIntolerance.extension",
                "sliceName": "evidence",
                "short": "A reference to a DiagnosticReport resource for investigations that confirm the certainty of the allergy or intolerance diagnosis.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence"
                        ]
                    }
                ]
            },
            {
                "id": "AllergyIntolerance.clinicalStatus",
                "path": "AllergyIntolerance.clinicalStatus",
                "short": "Defines whether the allergy or intolerance is active, inactive or resolved.",
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.clinicalStatus.extension:allergyIntoleranceEnd",
                "path": "AllergyIntolerance.clinicalStatus.extension",
                "sliceName": "allergyIntoleranceEnd",
                "short": "The date when the allergy or intolerance clinicalStatus is updated to inactive or resolved.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "AllergyIntolerance.verificationStatus",
                "path": "AllergyIntolerance.verificationStatus",
                "short": "Defines the assertion of the allergy or intolerance.",
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.code",
                "path": "AllergyIntolerance.code",
                "short": "This code identifies the allergy or intolerance.",
                "min": 1,
                "mustSupport": true,
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode"
                }
            },
            {
                "id": "AllergyIntolerance.patient",
                "path": "AllergyIntolerance.patient",
                "short": "Links the allergy or intolerance to the patient.",
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.reaction",
                "path": "AllergyIntolerance.reaction",
                "short": "Details about each adverse reaction event.",
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.reaction.substance",
                "path": "AllergyIntolerance.reaction.substance",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AllergySubstance"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.manifestation",
                "path": "AllergyIntolerance.reaction.manifestation",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation"
                }
            },
            {
                "id": "AllergyIntolerance.reaction.severity",
                "path": "AllergyIntolerance.reaction.severity",
                "short": "A clinical assessment of the severity of the reaction event as a whole.",
                "mustSupport": true
            },
            {
                "id": "AllergyIntolerance.reaction.exposureRoute",
                "path": "AllergyIntolerance.reaction.exposureRoute",
                "binding": {
                    "strength": "preferred",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute"
                }
            }
        ]
    }
}

Feedback

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Examples

Allergy - An example to illustrate an allergy to medication.
Example UKCore-AllergyIntolerance-Amoxicillin

Allergy entered in error - An example to illustrate an allergy which was entered in error and has been marked as ended.
Example UKCore-AllergyIntolerance-EnteredInError

Allergy evidence - An example to illustrate a reference to results of investigations that confirmed the certainty of the diagnosis for an allergy or intolerance.
Example UKCore-Extension-Evidence

Allergy List - An example to illustrate a list of allergies contained in a Bundle resource.
Example UKCore-Bundle-AllergyList

Example Usage Scenarios

The following are feasible use cases for the UK Core AllergyIntolerance profile:

  • Query for patient allergy information
  • Exchange patient allergy information within a FHIR Document or FHIR Message
  • Migration of allergies data between systems.

Profile Specific Implementation Guidance:

Use Case: Query

The query against a clinical system or shared record to return recorded allergies as AllergyIntolerance resources.

Returned results could be ordered by AllergyIntolerance.recordedDate and/or AllergyIntolerance.lastOccurrence.

Returned results MAY include multiple instances of the same allergy, as per the causative agent (AllergyIntolerance.code), but with different AllergyIntolerance.clinicalStatus values. The newer of such records either by AllergyIntolerance.recordedDate or AllergyIntolerance.lastOccurrence SHOULD be deemed the latest or current record of the allergy.

Use Case: Exchange

For when systems need to exchange allergy information within a point-to-point message. The AllergyIntolerance resources can be included within a FHIR Message (within the Bundle), or within a FHIR Document alongside other structured resources and text-based data.

Allergy information SHOULD NOT be duplicated between systems (and, in England, this aligns with the NHS Data Strategy). When exchanging allergies data between systems be mindful of whether the receiving system plans to persist the data. If persisted, processes SHALL be put in place to ensure the data is updated if/when the source record is updated.

Use Case: Migration

When allergy records are migrated between systems, the AllergyIntolerance resource could be used as a data migration standard.

Where migrated data is not coded, uses retired / invalidated codes, or coded with a terminology which cannot be mapped to SNOMED CT, then refer to the guidance on using degraded drug / non-drug allergy codes.


Mandatory and Must Support Data Elements

The following elements are identified as MustSupport, and it is expected that consumers and suppliers SHALL support these as per the MustSupport Guidance.

ElementReason
AllergyIntolerance.clinicalStatusDefines whether the allergy or intolerance is active, inactive or resolved.
AllergyIntolerance.verificationStatusDefines the assertion of the allergy or intolerance.
AllergyIntolerance.codeThis code identifies the allergy or intolerance.
AllergyIntolerance.patientLinks the allergy or intolerance to the patient.
AllergyIntolerance.reactionDetails about each adverse reaction event.
AllergyIntolerance.reaction.severityA clinical assessment of the severity of the reaction event as a whole.


Extensions

More information about the extensions on the UKCore-AllergyIntolerance profile can be found using the links below.

ExtensionContextLinkComment
evidenceAllergyIntolerance.extensionhttps://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-EvidenceA reference to a DiagnosticReport resource for investigations that confirm the certainty of the allergy or intolerance diagnosis.
allergyIntoleranceEndAllergyIntolerance.clinicalStatus.extensionhttps://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEndThe date when the allergy or intolerance clinicalStatus is updated to inactive or resolved.


Bindings (differential)

More information about the bindings to UK Core ValueSets can be found below.

ContextStrengthLink
AllergyIntolerance.codepreferredhttps://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode
AllergyIntolerance.reaction.substancepreferredhttps://fhir.hl7.org.uk/ValueSet/UKCore-AllergySubstance
AllergyIntolerance.reaction.manifestationpreferredhttps://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation
AllergyIntolerance.reaction.exposureRoutepreferredhttps://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute


verificationStatus

An optional value from a required terminology binding containing the values;

  • unconfirmed
  • confirmed
  • refuted
  • entered-in-error.

Note: The use of entered-in-error dictates the population of the AllergyIntolerance.clinicalStatus element, via the ait-1 and ait-2 constraints in the base resource.


code

Identifies the causative agent for the allergy or intolerance.

When recording an allergy to a medication substance, the provider system SHOULD use a dm+d concept class or alternatively, when the allergy is not recorded against a medication substance, the relevant set of SNOMED CT. These can be found within the ValueSet UKCore-AllergyCode.

Using transfer degraded drug / non-drug allergy codes


Degraded drug allergy codes can be used in three scenarios, with examples.

1. If only a text representation of the allergy is known.

Table View

AllergyIntolerance.id[0]UKCore-AllergyIntolerance-Sn-NonDrugAllergy-Example
AllergyIntolerance.clinicalStatus[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
AllergyIntolerance.clinicalStatus[0].coding[0].code[0]active
AllergyIntolerance.clinicalStatus[0].coding[0].display[0]Active
AllergyIntolerance.verificationStatus[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
AllergyIntolerance.verificationStatus[0].coding[0].code[0]confirmed
AllergyIntolerance.verificationStatus[0].coding[0].display[0]Confirmed
AllergyIntolerance.code[0].coding[0].system[0]http://snomed.info/sct
AllergyIntolerance.code[0].coding[0].code[0]196471000000108
AllergyIntolerance.code[0].coding[0].display[0]Transfer-degraded non-drug allergy (record artifact)
AllergyIntolerance.code[0].text[0]Latex
AllergyIntolerance.patient[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example

Tree View

AllergyIntolerance

XML View

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance-Sn-NonDrugAllergy-Example" />
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
            <display value="Confirmed" />
        </coding>
    </verificationStatus>
    <!--  **************Snippet start**************  -->
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="196471000000108" />
            <display value="Transfer-degraded non-drug allergy (record artifact)" />
        </coding>
        <text value="Latex" />
    </code>
    <!--  **************Snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
</AllergyIntolerance>

JSON View

{
    "resourceType": "AllergyIntolerance",
    "id": "UKCore-AllergyIntolerance-Sn-NonDrugAllergy-Example",
    "clinicalStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
                "code": "active",
                "display": "Active"
            }
        ]
    },
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
                "code": "confirmed",
                "display": "Confirmed"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196471000000108",
                "display": "Transfer-degraded non-drug allergy (record artifact)"
            }
        ],
        "text": "Latex"
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    }
}

2. If a text representation of the allergy is known but any associated coding is not recognised by the system.

Table View

AllergyIntolerance.id[0]UKCore-AllergyIntolerance-Sn-DrugAllergy-Example
AllergyIntolerance.clinicalStatus[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
AllergyIntolerance.clinicalStatus[0].coding[0].code[0]active
AllergyIntolerance.clinicalStatus[0].coding[0].display[0]Active
AllergyIntolerance.verificationStatus[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
AllergyIntolerance.verificationStatus[0].coding[0].code[0]confirmed
AllergyIntolerance.verificationStatus[0].coding[0].display[0]Confirmed
AllergyIntolerance.code[0].coding[0].system[0]http://snomed.info/sct
AllergyIntolerance.code[0].coding[0].code[0]196461000000101
AllergyIntolerance.code[0].coding[0].display[0]Transfer-degraded drug allergy (record artifact)
AllergyIntolerance.code[0].text[0]9339101000001105 | Septrin
AllergyIntolerance.patient[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example

Tree View

AllergyIntolerance

XML View

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance-Sn-DrugAllergy-Example" />
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
            <display value="Confirmed" />
        </coding>
    </verificationStatus>
    <!--  **************Snippet start**************  -->
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="196461000000101" />
            <display value="Transfer-degraded drug allergy (record artifact)" />
        </coding>
        <text value="9339101000001105 | Septrin" />
    </code>
    <!--  **************Snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
</AllergyIntolerance>

JSON View

{
    "resourceType": "AllergyIntolerance",
    "id": "UKCore-AllergyIntolerance-Sn-DrugAllergy-Example",
    "clinicalStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
                "code": "active",
                "display": "Active"
            }
        ]
    },
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
                "code": "confirmed",
                "display": "Confirmed"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196461000000101",
                "display": "Transfer-degraded drug allergy (record artifact)"
            }
        ],
        "text": "9339101000001105 | Septrin"
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    }
}

Note: “Septrin” is a long discontinued brand name of an antibiotic.

3. If a pre-coordinated allergy code is known which this is not part of the permitted value set for causative agent defined above.

Table View
AllergyIntolerance.id[0]UKCore-AllergyIntolerance-Sn-DrugAllergyToEggProtein-Example
AllergyIntolerance.clinicalStatus[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
AllergyIntolerance.clinicalStatus[0].coding[0].code[0]active
AllergyIntolerance.clinicalStatus[0].coding[0].display[0]Active
AllergyIntolerance.verificationStatus[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
AllergyIntolerance.verificationStatus[0].coding[0].code[0]confirmed
AllergyIntolerance.verificationStatus[0].coding[0].display[0]Confirmed
AllergyIntolerance.code[0].coding[0].system[0]http://snomed.info/sct
AllergyIntolerance.code[0].coding[0].code[0]196461000000101
AllergyIntolerance.code[0].coding[0].display[0]Transfer-degraded drug allergy (record artifact)
AllergyIntolerance.code[0].text[0]213020009 | Allergy to egg protein
AllergyIntolerance.patient[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example

Tree View

AllergyIntolerance

XML View

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance-Sn-DrugAllergyToEggProtein-Example" />
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
            <display value="Confirmed" />
        </coding>
    </verificationStatus>
    <!--  **************Snippet start**************  -->
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="196461000000101" />
            <display value="Transfer-degraded drug allergy (record artifact)" />
        </coding>
        <text value="213020009 | Allergy to egg protein" />
    </code>
    <!--  **************Snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
</AllergyIntolerance>

JSON View

{
    "resourceType": "AllergyIntolerance",
    "id": "UKCore-AllergyIntolerance-Sn-DrugAllergyToEggProtein-Example",
    "clinicalStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
                "code": "active",
                "display": "Active"
            }
        ]
    },
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
                "code": "confirmed",
                "display": "Confirmed"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "196461000000101",
                "display": "Transfer-degraded drug allergy (record artifact)"
            }
        ],
        "text": "213020009 | Allergy to egg protein"
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    }
}

Handling of 'No known allergies'

There can be an explicit assertion of ‘No Known Allergies’ using the SNOMED CT 'No known allergy' hierarchy 716186003 | No known allergy. The parent concept, or any child concept MAY be used.

Example of AllergyIntolerance.code usage for 'No known drug allergy':

Table View

AllergyIntolerance.id[0]UKCore-AllergyIntolerance-Sn-NegHandlNoKnownAllergies-Example
AllergyIntolerance.clinicalStatus[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical
AllergyIntolerance.clinicalStatus[0].coding[0].code[0]active
AllergyIntolerance.clinicalStatus[0].coding[0].display[0]Active
AllergyIntolerance.verificationStatus[0].coding[0].system[0]http://terminology.hl7.org/CodeSystem/allergyintolerance-verification
AllergyIntolerance.verificationStatus[0].coding[0].code[0]confirmed
AllergyIntolerance.verificationStatus[0].coding[0].display[0]Confirmed
AllergyIntolerance.code[0].coding[0].system[0]http://snomed.info/sct
AllergyIntolerance.code[0].coding[0].code[0]409137002
AllergyIntolerance.code[0].coding[0].display[0]No known drug allergy (situation)
AllergyIntolerance.patient[0].reference[0]Patient/UKCore-Patient-RichardSmith-Example

Tree View

AllergyIntolerance

XML View

<AllergyIntolerance xmlns="http://hl7.org/fhir">
    <id value="UKCore-AllergyIntolerance-Sn-NegHandlNoKnownAllergies-Example" />
    <clinicalStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical" />
            <code value="active" />
            <display value="Active" />
        </coding>
    </clinicalStatus>
    <verificationStatus>
        <coding>
            <system value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification" />
            <code value="confirmed" />
            <display value="Confirmed" />
        </coding>
    </verificationStatus>
    <!--  **************Snippet start**************  -->
    <code>
        <coding>
            <system value="http://snomed.info/sct" />
            <code value="409137002" />
            <display value="No known drug allergy (situation)" />
        </coding>
    </code>
    <!--  **************Snippet end**************  -->
    <patient>
        <reference value="Patient/UKCore-Patient-RichardSmith-Example" />
    </patient>
</AllergyIntolerance>

JSON View

{
    "resourceType": "AllergyIntolerance",
    "id": "UKCore-AllergyIntolerance-Sn-NegHandlNoKnownAllergies-Example",
    "clinicalStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
                "code": "active",
                "display": "Active"
            }
        ]
    },
    "verificationStatus": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
                "code": "confirmed",
                "display": "Confirmed"
            }
        ]
    },
    "code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "409137002",
                "display": "No known drug allergy (situation)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/UKCore-Patient-RichardSmith-Example"
    }
}

If other AllergyIntolerance resources exist in the patient record with a AllergyIntolerance.clinicalStatus of active then the system SHALL ignore the 'No Known Allergies' resource instance. The existence of recorded and active allergies takes precedence over instances of 'No Known Allergies' records.


Use of plain text only

The representation of the causative agent as text is supported within the FHIR standard but this SHOULD only be used as a last resort if a suitable coded term does not exist within the SNOMED CT terminology or if using a degraded allergy code is not appropriate.

Use of nullFlavor

The UK Core recommendation is that the nullFlavor is not used for the causative agent, even though it is permitted within the FHIR standard.


patient

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Patient.


encounter

Where possible, it is expected that the resource being referenced SHOULD conform to Profile UKCore-Encounter.


onset[x]

Record of the date and/or time of the onset of the reaction caused by the allergy or intolerance which can be recorded in one of five ways;

  • onsetDateTime
  • onsetAge
  • onsetPeriod
  • onsetRange
  • onsetString.

Provider Systems

Provider systems are recommended to support at least AllergyIntolerance.onsetDateTime and AllergyIntolerance.onsetAge where this date is available.

It is recommended not to record the onset using an AllergyIntolerance.onsetPeriod or AllergyIntolerance.onsetRange as these data types are complex and less useful. If the exact onset date is not known, but was between two known dates, e.g. 2018 and 2019, then use the lower/older date as the AllergyIntolerance.onsetDateTime instead of using an AllergyIntolerance.onsetPeriod.

It is recommended not to record the onset using an AllergyIntolerance.onsetString as this data will not be machine processable.

Provider Systems

Consumer systems SHALL be able to handle any of the AllergyIntolerance.onset data types.


recordedDate

The date the first version of the resource instance was recorded.

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

If the instance of the resource is updated via an operation like a RESTful PATCH or PUT then the AllergyIntolerance.recordedDate is not updated and remains the date the resource instance was recorded.


recorder

A reference to the individual who recorded the record and takes responsibility for its content.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:


asserter

A reference to the source of the information about the allergy.

Where possible, it is expected that the resource being referenced SHOULD conform to one of the following UK Core profiles:

Provider Systems

Provider systems SHOULD provide at least the following minimum data within the referenced resource.

Practitioner

  • identifier
  • name

PractitionerRole

  • identifier
  • practitioner (as above) OR organisation.identifier OR healthcareService.identifier

Patient

  • identifier:nhsNumber
  • name

RelatedPerson

  • identifier
  • name
  • patient

Where a human asserter is not captured or cannot be confirmed, i.e. the asserter is not a Practitioner, Patient or RelatedPerson, the provider systems SHOULD reference a PractitionerRole.organisation and/or PractitionerRole.healthcareService within a PractitionerRole resource, using the associated ODS code, as per the following example, asserted by "MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST".

Example of PractitionerRole.organisation for ODS code usage:

Table View

PractitionerRole.id[0]UKCore-PractitionerRole-Sn-Organization-Code-Example
PractitionerRole.identifier[0].system[0]https://fhir.nhs.uk/Id/sds-role-profile-id
PractitionerRole.identifier[0].value[0]100334993514
PractitionerRole.organization[0].identifier[0].system[0]https://fhir.nhs.uk/Id/ods-organization-code
PractitionerRole.organization[0].identifier[0].value[0]RD8
PractitionerRole.organization[0].display[0]MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

Tree View

PractitionerRole

XML View

<PractitionerRole xmlns="http://hl7.org/fhir">
    <id value="UKCore-PractitionerRole-Sn-Organization-Code-Example" />
    <!--  **************snippet start**************  -->
    <identifier>
        <system value="https://fhir.nhs.uk/Id/sds-role-profile-id" />
        <value value="100334993514" />
    </identifier>
    <organization>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/ods-organization-code" />
            <value value="RD8" />
        </identifier>
        <display value="MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST" />
    </organization>
    <!--  **************snippet end**************  -->
</PractitionerRole>

JSON View

{
    "resourceType": "PractitionerRole",
    "id": "UKCore-PractitionerRole-Sn-Organization-Code-Example",
    "identifier":  [
        {
            "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
            "value": "100334993514"
        }
    ],
    "organization": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
            "value": "RD8"
        },
        "display": "MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST"
    }
}

lastOccurrence

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


note

An optional element for when the clinical user wishes to provide supporting textual information for the allergy record that cannot be conveyed within other elements of the resource.

Provider Systems

Where a provider system only has the capability to record a note at one level it SHOULD populate the AllergyIntolerance.note elements with any notes data captured within the system, irrespective of the data level that the system uses to capture that data.

Where a provider system has the capability to record a note at both the AllergyIntolerance and at the AllergyIntolerance.reaction level it SHOULD populate both with the relevant notes applicable to each level.

Provider Systems

Consumer systems SHALL be able to handle both multiple AllergyIntolerance.note and multiple AllergyIntolerance.reaction.note elements.


reaction

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

The AllergyIntolerance.reaction is optional, but where a AllergyIntolerance.reaction.severity is available in the provider system it SHALL be included to convey severity even if no other reaction details are explicitly available. If this is the case the AllergyIntolerance.reaction.manifestation SHALL be coded as the nullFlavor NI.

reaction.substance

An element to record the specific substance or pharmaceutical product considered to be responsible for event using the ValueSet UKCore-AllergySubstance

reaction.manifestation

A mandatory element if a AllergyIntolerance.reaction is recorded for the clinical symptoms and/or signs that are observed or associated with the adverse reaction event.

Use nullFlavor NI for the case when a AllergyIntolerance.reaction.severity needs to be shared but where a AllergyIntolerance.reaction.manifestation is not known.

reaction.severity

An optional value from a required terminology binding containing the values;

  • mild
  • moderate
  • severe

Provider Systems

Where a severity is available in the provider system it SHALL be included to convey severity even if no other reaction details are explicitly available.

Where the severity is not known, this element SHOULD be omitted.

Provider Systems

Use of this element when populated as severe MAY be used to express life threatening allergies, used in conjunction with the AllergyIntolerance.criticality element.

An omitted AllergyIntolerance.reaction.severity will either mean severity data is not available within the provider system or the severity is not known by the provider system.

reaction.exposureRoute

An optional element to identify the route by which the patient was exposed to the substance.

Provider Systems

If this data is available the binding SHOULD be to the ValueSet UKCore-SubstanceOrProductAdministrationRoute.

Provider Systems

Consumer systems are recommended not to include this coded information within automated clinical decision support. This is because it could either mean two quite different things;

  1. The reaction only occurs if the substance enters the body via the specified route, implying the use of other routes is safe.

OR

  1. The reaction was identified when the substance entered the body via the specified route, but could also react when using other routes.

reaction.note

An optional element for when the clinical user wishes to provide supporting textual information for the reaction that cannot be conveyed within other elements of the backbone element.

See the related guidance above for AllergyIntolerance.note.