CH AllergyIntolerance (R4)
3.0.0 - trial-use Switzerland flag

This page is part of the CH-AllergyIntolerance (R4) (v3.0.0: STU 3) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: CHAllergyIntolerance - Detailed Descriptions

Active as of 2024-12-18

Definitions for the ch-allergyintolerance resource profile.

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

0. AllergyIntolerance
Must Supporttrue
Impose ProfileThis profile also requires that the instance also conform this additional profile:
2. AllergyIntolerance.extension
SlicingThis element introduces a set of slices on AllergyIntolerance.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. AllergyIntolerance.extension:abatement-datetime
    Slice Nameabatement-datetime
    Definition

    The date or estimated date that the condition resolved or went into remission.

    ShortAbatement datetime
    Control0..1
    TypeExtension(Abatement) (Extension Type: Choice of: dateTime, Age, Period, Range, string)
    Must Supporttrue
    6. AllergyIntolerance.clinicalStatus
    Must Supporttrue
    8. AllergyIntolerance.verificationStatus
    Must Supporttrue
    10. AllergyIntolerance.type
    Must Supporttrue
    12. AllergyIntolerance.category
    Must Supporttrue
    14. AllergyIntolerance.criticality
    Must Supporttrue
    16. AllergyIntolerance.code
    Control1..?
    BindingUnless not suitable, these codes SHALL be taken from CH AllergyIntolerance
    (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceValueSet)
    Must Supporttrue
    18. AllergyIntolerance.onset[x]
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    SlicingThis element introduces a set of slices on AllergyIntolerance.onset[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 20. AllergyIntolerance.onset[x]:onsetDateTime
      Slice NameonsetDateTime
      Control0..1
      TypedateTime
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      22. AllergyIntolerance.reaction
      Must Supporttrue
      24. AllergyIntolerance.reaction.extension:certainty
      Slice Namecertainty
      ShortStatement about the degree of clinical certainty that the specific substance was the cause of the manifestation in this reaction event.
      26. AllergyIntolerance.reaction.extension:duration
      Slice Nameduration
      ShortThe amount of time that the Adverse Reaction persisted
      28. AllergyIntolerance.reaction.extension:location
      Slice Namelocation
      ShortThe anatomical location / body site(s) where the symptoms manifested
      30. AllergyIntolerance.reaction.extension:exposureDate
      Slice NameexposureDate
      ShortRecord of the date and/or time of the first exposure to the Substance for this Reaction Event.
      32. AllergyIntolerance.reaction.extension:exposureDuration
      Slice NameexposureDuration
      ShortThe amount of time the individual was exposed to the Substance
      34. AllergyIntolerance.reaction.extension:management
      Slice Namemanagement
      ShortText description about the clinical management provided.
      36. AllergyIntolerance.reaction.substance
      BindingUnless not suitable, these codes SHALL be taken from CH AllergyIntolerance Reaction Substance
      (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionSubstanceValueSet)
      Must Supporttrue
      38. AllergyIntolerance.reaction.manifestation
      BindingUnless not suitable, these codes SHALL be taken from CH AllergyIntolerance Reaction Manifestation
      (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionManifestationValueSet)
      Must Supporttrue
      40. AllergyIntolerance.reaction.onset
      Must Supporttrue
      42. AllergyIntolerance.reaction.severity
      Must Supporttrue

      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.

      ShortCH IPS AllergyIntoleranceAllergy 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
      Must Supporttrue
      Impose ProfileThis profile also requires that the instance also conform this additional profile:
      Summaryfalse
      Alternate NamesAllergy, Intolerance, Adverse Reaction
      Invariantsait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. (verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists())
      ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty())
      dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. (verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists())
      ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty())
      2. AllergyIntolerance.implicitRules
      Definition

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

      ShortA set of rules under which this content was created
      Comments

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

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

      An Extension


      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.

      ShortExtensionAdditional content defined by implementations
      Comments

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

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

        The date or estimated date that the condition resolved or went into remission.

        ShortAbatement datetime
        Comments

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

        Control0..1
        TypeExtension(Abatement) (Extension Type: Choice of: dateTime, Age, Period, Range, string)
        Is Modifierfalse
        Must Supporttrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        8. 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())
        10. 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.
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. 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.
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        14. 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 AllergyIntoleranceTypehttp://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1
        (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1)

        Identification of the underlying physiological mechanism for a Reaction Risk.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Alternate NamesCategory, Class
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        16. 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 AllergyIntoleranceCategoryhttp://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1
        (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
        Must Supporttrue
        Summarytrue
        Alternate NamesCategory, Type, Reaction Type, Class
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. 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 AllergyIntoleranceCriticalityhttp://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1
        (required to http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1)

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

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

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

        ShortCode that identifies the allergy or intolerance
        Comments

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

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

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

        Control10..1
        BindingUnless not suitable, these codes SHALL be taken from For example codes, see CH AllergyIntolerancehttp://hl7.org/fhir/ValueSet/allergyintolerance-code
        (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceValueSet)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Alternate NamesCode
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. AllergyIntolerance.patient
        Definition

        The patient who has the allergy or intolerance.

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

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

        ShortWhen allergy or intolerance was identified
        Control0..1
        TypeChoice of: dateTime, Age, Period, Range, string
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on AllergyIntolerance.onset[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • type @ $this
        • 26. AllergyIntolerance.onset[x]:onsetDateTime
          Slice NameonsetDateTime
          Definition

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

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

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

          ShortAdverse Reaction Events linked to exposure to substance
          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          30. 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.

          ShortStatement about the degree of clinical certainty that the specific substance was the cause of the manifestation in this reaction event.
          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())
          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())
          32. AllergyIntolerance.reaction.extension:duration
          Slice Nameduration
          Definition

          The amount of time that the Adverse Reaction persisted.

          ShortThe amount of time that the Adverse Reaction 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())
          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())
          34. AllergyIntolerance.reaction.extension:location
          Slice Namelocation
          Definition

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

          ShortThe anatomical location / body site(s) where the symptoms manifested
          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())
          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())
          36. 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.

          ShortRecord of the date and/or time of the first exposure to the Substance for this Reaction Event.
          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())
          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())
          38. AllergyIntolerance.reaction.extension:exposureDuration
          Slice NameexposureDuration
          Definition

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

          ShortThe amount of time the individual was exposed to the 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())
          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())
          40. 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())
          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())
          42. AllergyIntolerance.reaction.extension:management
          Slice Namemanagement
          Definition

          Text description about the clinical management provided.

          ShortText description about the clinical management provided.
          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())
          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())
          44. 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())
          46. 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
          BindingUnless not suitable, these codes SHALL be taken from For example codes, see CH AllergyIntolerance Reaction Substancehttp://hl7.org/fhir/ValueSet/substance-code
          (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionSubstanceValueSet)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. 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..*
          BindingUnless not suitable, these codes SHALL be taken from For example codes, see CH AllergyIntolerance Reaction Manifestationhttp://hl7.org/fhir/ValueSet/clinical-findings
          (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionManifestationValueSet)
          TypeCodeableConcept
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Alternate NamesSymptoms, Signs
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. 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
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. 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 AllergyIntoleranceSeverityhttp://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1
          (required to http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1)

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

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

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

          ShortCH IPS AllergyIntolerance
          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
          Must Supporttrue
          Impose ProfileThis profile also requires that the instance also conform this additional profile:
          Summaryfalse
          Alternate NamesAllergy, Intolerance, Adverse Reaction
          Invariantsait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. (verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists())
          ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty())
          dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
          dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
          dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
          dom-6: A resource should have narrative for robust management (text.`div`.exists())
          2. AllergyIntolerance.id
          Definition

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

          ShortLogical id of this artifact
          Comments

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

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

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

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

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

          ShortA set of rules under which this content was created
          Comments

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

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

          The base language in which the resource is written.

          ShortLanguage of the resource content
          Comments

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

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

          A human language.

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

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

          ShortText summary of the resource, for human interpretation
          Comments

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

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

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

          ShortContained, inline Resources
          Comments

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

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

          An Extension

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

            The date or estimated date that the condition resolved or went into remission.

            ShortAbatement datetime
            Comments

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

            Control0..1
            TypeExtension(Abatement) (Extension Type: Choice of: dateTime, Age, Period, Range, string)
            Is Modifierfalse
            Must Supporttrue
            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.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())
            20. 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()))
            22. 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.
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            24. 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.
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. 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
            Must Supporttrue
            Summarytrue
            Alternate NamesCategory, Class
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. 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
            Must Supporttrue
            Summarytrue
            Alternate NamesCategory, Type, Reaction Type, Class
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. 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
            Must Supporttrue
            Summarytrue
            Alternate NamesSeverity, Seriousness, Contra-indication, Risk
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. AllergyIntolerance.code
            Definition

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

            ShortCode that identifies the allergy or intolerance
            Comments

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

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

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

            Control1..1
            BindingUnless not suitable, these codes SHALL be taken from CH AllergyIntolerance
            (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceValueSet)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Alternate NamesCode
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. AllergyIntolerance.patient
            Definition

            The patient who has the allergy or intolerance.

            ShortWho the sensitivity is for
            Control1..1
            TypeReference(CH IPS Patient)
            Is Modifierfalse
            Summarytrue
            Alternate NamesPatient
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. 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()))
            38. AllergyIntolerance.onset[x]
            Definition

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

            ShortWhen allergy or intolerance was identified
            Control0..1
            TypeChoice of: dateTime, Age, Period, Range, string
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on AllergyIntolerance.onset[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • 40. AllergyIntolerance.onset[x]:onsetDateTime
              Slice NameonsetDateTime
              Definition

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

              ShortWhen allergy or intolerance was identified
              Control0..1
              TypedateTime
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              42. 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()))
              44. 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()))
              46. 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()))
              48. 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()))
              50. 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()))
              52. AllergyIntolerance.reaction
              Definition

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

              ShortAdverse Reaction Events linked to exposure to substance
              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              54. 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
              56. 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
              • 58. 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.

                ShortStatement about the degree of clinical certainty that the specific substance was the cause of the manifestation in this reaction event.
                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())
                60. AllergyIntolerance.reaction.extension:duration
                Slice Nameduration
                Definition

                The amount of time that the Adverse Reaction persisted.

                ShortThe amount of time that the Adverse Reaction 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())
                62. AllergyIntolerance.reaction.extension:location
                Slice Namelocation
                Definition

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

                ShortThe anatomical location / body site(s) where the symptoms manifested
                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())
                64. 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.

                ShortRecord of the date and/or time of the first exposure to the Substance for this Reaction Event.
                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())
                66. AllergyIntolerance.reaction.extension:exposureDuration
                Slice NameexposureDuration
                Definition

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

                ShortThe amount of time the individual was exposed to the 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())
                68. 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())
                70. AllergyIntolerance.reaction.extension:management
                Slice Namemanagement
                Definition

                Text description about the clinical management provided.

                ShortText description about the clinical management provided.
                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())
                72. 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())
                74. 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
                BindingUnless not suitable, these codes SHALL be taken from CH AllergyIntolerance Reaction Substance
                (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionSubstanceValueSet)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                76. 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..*
                BindingUnless not suitable, these codes SHALL be taken from CH AllergyIntolerance Reaction Manifestation
                (extensible to http://fhir.ch/ig/ch-allergyintolerance/ValueSet/CHAllergyIntoleranceReactionManifestationValueSet)
                TypeCodeableConcept
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Alternate NamesSymptoms, Signs
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                78. 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()))
                80. 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
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                82. 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
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                84. 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()))
                86. 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()))