Status: Active: DRAFT: For Review

Introduction

This profile sets out the expectations for the interweave allergy intolerance resource. We use the UKCore-AllergyIntolerance structure definition as a base to this profile.

Mandatory fields

The following mandatory fields are defined:

1. verificationStatus – Specify whether the allergy/intolerance is confirmed or unconfirmed.

2. type – Specify whether an allergy or intolerance is being modelled.

3. patient – The person who has the allergy/intolerance.

4. recordedDate – This should be the date that the allergy/intolerance was recorded. The date that the allergy/intolerance was identified should be captured in the onset[x] field.

5. code – What is the allergy or intolerance. We stipulate a preferred binding to the SNOMED / dm+d concepts below, with the understanding that local code sets are widely in use and mapping from local codes to SNOMED / dm+d maybe troublesome. However, every effort should be made to map, and where it is deemed unachievable, you will need to contact interweave team to gain explicit permission to use your own local code set:

   • A set of codes from the following dm+d (dictionary of medicines and devices) concept classes that define a medication or medication ingredient that the patient has an allergy or intolerance to:

     • VTM – Virtual Therapeutic Moiety
     • VMP – Virtual Medicinal Product
     • AMP – Actual Medicinal Product
     • Ingredient

   • A set of codes from the SNOMED CT UK coding system that:

     • identify a substance (105590001) or pharmaceutical / biologic product (373873005) that the patient has an allergy or intolerance to
     • state that the patient has no known allergy (716186003)
     • provide a degrade of information about a drug (196461000000101) or non-drug allergy (196471000000108).

   • Where no dm+d or SNOMED CT coded information is available, a specific code from the nullFlavor Code System can be used instead to indicate this.

Must Support fields

In addition the following fields are "Must Support" – i.e., they must be populated if relevant and known.

1. clinicalStatus – It is important to provide the clinical status of the allergy or intolerance. Please See Invariants here which must be observed when populating this field.

   • AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error.

   • AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error

   • clinicalStatus.allergyIntoleranceEnd - The date when the allergy or intolerance clinicalStatus is updated to inactive or resolved.

2. category – The classification of the substance or pharmaceutical product that is considered to be responsible for the adverse reaction. This is a must support field as not all clinical systems currently capture this information.

3. criticality – Used to record the severity of the reaction.

4. Onset[x] – When the allergy or intolerance was identified. The Estimated or actual date, date-time, or age when allergy or intolerance was identified. We have removed the Range and String data types from this field as they were deemed unnecessary, and it reduced the complexity of processing multiple data types for the data consumer.

5. asserter – The source of the information about the allergy. This can be a reference to a patient, related person, or a practitioner.

6. reaction – This field can be used to present the history of known reactions. The reaction field has a number of important child fields that should/must be provided as below:

   • manifestation – This is a mandatory field when providing the reaction. It is used to record the signs/symptoms of the reaction.

   • onset – this is a must support field which gives the date/time of when the reaction occurred.

   • severity – another important must support field which details the severity of the reaction event.

   • substance – This is an optional field, but it is important to note its usage. This is the specific substance or pharmaceutical product considered to be responsible for the event. e.g. If a patient is allergic to egg, if they are given a vaccine containing egg, which initiates a reaction, it is the vaccine that should be recorded here.

Optional fields

Other fields are optional and may be populated if known – on the understanding that not all data consumers will necessarily make use of them. Points of note include:

• identifier – Usually a Local Id that is provided which can be quoted if manually getting in touch to find out more information. In most Interweave profiles this is a must support field, however, it is more likely that a patient identifier(NHS number) would be quoted when wanting to find out more about a persons allergies, and therefore this is marked as optional.

• encounter – This is an extension introduced by care connect to pre-adopt the new ‘encounter’ field which is present in R4. It can be used to provide a link to the encounter where the allergy or intolerance was asserted.

• allergyEnd – Option to provide the date and reason that the allergy is not longer valid.

• evidence – Option to provide a reference to a diagnostic report which confirms the presence of an allergy or an intolerance.

• recorder: Option to provide the practitioner or patient who recorded the adverse reaction.

• note – Additional information about the allergy/intolerance, which is not captured elsewhere, can be entered within the notes section. For example, this could be information about how to care for an individual after exposure to a reactive substance. Care must be taken when populating this field, and only information which is deemed suitable for use within the shared care record should be populated here.

Discouraged or Removed fields

• last Occurrence – This field has been discouraged. It is used to record the date/time of the last known occurrence of a reaction. However, it is deemed that this could be misleading unless records are routinely checked and kept up to date.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from UKCoreAllergyIntolerance

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance		0..*	UKCoreAllergyIntolerance	Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
identifier
system		1..1	uri	The namespace for the identifier value
value		1..1	string	The value that is unique
assigner		0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
clinicalStatus
id		0..0
verificationStatus		1..1	CodeableConcept	Defines the assertion of the allergy or intolerance.
type	S	1..1	code	allergy | intolerance - Underlying mechanism (if known)
category	S	0..*	code	food | medication | environment | biologic
criticality	S	0..1	code	low | high | unable-to-assess
code
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
patient		1..1	Reference(InterweavePatient)	Links the allergy or intolerance to the patient.
encounter		0..1	Reference(InterweaveEncounter)	Encounter when the allergy or intolerance was asserted
onset[x]	S	0..1		When allergy or intolerance was identified
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
recordedDate	S	1..1	dateTime	Date first version of the resource instance was recorded
recorder		0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Who recorded the sensitivity
asserter	S	0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Source of the information about the allergy
lastOccurrence		0..1	dateTime	DISCOURAGED - maybe misleading unless information is kept acutely up to date.
reaction
id		0..0
substance
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
onset	S	0..1	dateTime	Date(/time) when manifestations showed
exposureRoute
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
note		0..0
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	UKCoreAllergyIntolerance	Allergy or Intolerance (generally: Risk of adverse reaction to a substance) ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for extension				Content/Rules for all slices
evidence		0..*	Reference(DiagnosticReport)	A reference to a DiagnosticReport resource for investigations that confirm the certainty of the allergy or intolerance diagnosis. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
clinicalStatus	?!SΣC	0..1	CodeableConcept	Defines whether the allergy or intolerance is active, inactive or resolved. Binding: AllergyIntoleranceClinicalStatusCodes (required): The clinical status of the allergy or intolerance.
Slices for extension				Content/Rules for all slices
allergyIntoleranceEnd		0..1	(Complex)	The date when the allergy or intolerance clinicalStatus is updated to inactive or resolved. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd
verificationStatus	?!SΣC	1..1	CodeableConcept	Defines the assertion of the allergy or intolerance. Binding: AllergyIntoleranceVerificationStatusCodes (required): Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
type	SΣ	1..1	code	allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category	SΣ	0..*	code	food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality	SΣ	0..1	code	low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code	SΣ	1..1	CodeableConcept	This code identifies the allergy or intolerance. Binding: UK Core Allergy Code (preferred)
patient	SΣ	1..1	Reference(InterweavePatient)	Links the allergy or intolerance to the patient.
encounter		0..1	Reference(InterweaveEncounter)	Encounter when the allergy or intolerance was asserted
onset[x]	S	0..1		When allergy or intolerance was identified
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
recordedDate	S	1..1	dateTime	Date first version of the resource instance was recorded
recorder		0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Who recorded the sensitivity
asserter	SΣ	0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Source of the information about the allergy
lastOccurrence		0..1	dateTime	DISCOURAGED - maybe misleading unless information is kept acutely up to date.
reaction	S	0..*	BackboneElement	Details about each adverse reaction event.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event Binding: UK Core Allergy Manifestation (preferred)
onset	S	0..1	dateTime	Date(/time) when manifestations showed
severity	S	0..1	code	A clinical assessment of the severity of the reaction event as a whole. Binding: AllergyIntoleranceSeverity (required): Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
AllergyIntolerance.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
AllergyIntolerance.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
AllergyIntolerance.clinicalStatus	required	AllergyIntoleranceClinicalStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1 from the FHIR Standard
AllergyIntolerance.verificationStatus	required	AllergyIntoleranceVerificationStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1 from the FHIR Standard
AllergyIntolerance.type	required	AllergyIntoleranceType http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1 from the FHIR Standard
AllergyIntolerance.category	required	AllergyIntoleranceCategory http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1 from the FHIR Standard
AllergyIntolerance.criticality	required	AllergyIntoleranceCriticality http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1 from the FHIR Standard
AllergyIntolerance.code	preferred	UKCoreAllergyCode https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode from this IG
AllergyIntolerance.reaction.manifestation	preferred	UKCoreAllergyManifestation https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation from this IG
AllergyIntolerance.reaction.severity	required	AllergyIntoleranceSeverity http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ait-1	error	AllergyIntolerance	AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. : verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()
ait-2	error	AllergyIntolerance	AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	AllergyIntolerance	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	UKCoreAllergyIntolerance	Allergy or Intolerance (generally: Risk of adverse reaction to a substance) ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
evidence		0..*	Reference(DiagnosticReport)	A reference to a DiagnosticReport resource for investigations that confirm the certainty of the allergy or intolerance diagnosis. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External ids for this item
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
clinicalStatus	?!SΣC	0..1	CodeableConcept	Defines whether the allergy or intolerance is active, inactive or resolved. Binding: AllergyIntoleranceClinicalStatusCodes (required): The clinical status of the allergy or intolerance.
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
allergyIntoleranceEnd		0..1	(Complex)	The date when the allergy or intolerance clinicalStatus is updated to inactive or resolved. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
verificationStatus	?!SΣC	1..1	CodeableConcept	Defines the assertion of the allergy or intolerance. Binding: AllergyIntoleranceVerificationStatusCodes (required): Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
type	SΣ	1..1	code	allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category	SΣ	0..*	code	food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality	SΣ	0..1	code	low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code	SΣ	1..1	CodeableConcept	This code identifies the allergy or intolerance. Binding: UK Core Allergy Code (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
patient	SΣ	1..1	Reference(InterweavePatient)	Links the allergy or intolerance to the patient.
encounter		0..1	Reference(InterweaveEncounter)	Encounter when the allergy or intolerance was asserted
onset[x]	S	0..1		When allergy or intolerance was identified
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
recordedDate	S	1..1	dateTime	Date first version of the resource instance was recorded
recorder		0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Who recorded the sensitivity
asserter	SΣ	0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Source of the information about the allergy
lastOccurrence		0..1	dateTime	DISCOURAGED - maybe misleading unless information is kept acutely up to date.
note		0..*	Annotation	Additional text not captured in other fields
reaction	S	0..*	BackboneElement	Details about each adverse reaction event.
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
substance		0..1	CodeableConcept	Specific substance or pharmaceutical product considered to be responsible for event Binding: UK Core Allergy Substance (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event Binding: UK Core Allergy Manifestation (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
description		0..1	string	Description of the event as a whole
onset	S	0..1	dateTime	Date(/time) when manifestations showed
severity	S	0..1	code	A clinical assessment of the severity of the reaction event as a whole. Binding: AllergyIntoleranceSeverity (required): Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
exposureRoute		0..1	CodeableConcept	How the subject was exposed to the substance Binding: UK Core Substance Or Product Administration Route (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
AllergyIntolerance.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
AllergyIntolerance.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
AllergyIntolerance.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
AllergyIntolerance.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
AllergyIntolerance.clinicalStatus	required	AllergyIntoleranceClinicalStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1 from the FHIR Standard
AllergyIntolerance.verificationStatus	required	AllergyIntoleranceVerificationStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1 from the FHIR Standard
AllergyIntolerance.type	required	AllergyIntoleranceType http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1 from the FHIR Standard
AllergyIntolerance.category	required	AllergyIntoleranceCategory http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1 from the FHIR Standard
AllergyIntolerance.criticality	required	AllergyIntoleranceCriticality http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1 from the FHIR Standard
AllergyIntolerance.code	preferred	UKCoreAllergyCode https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode from this IG
AllergyIntolerance.reaction.substance	preferred	UKCoreAllergySubstance https://fhir.hl7.org.uk/ValueSet/UKCore-AllergySubstance from this IG
AllergyIntolerance.reaction.manifestation	preferred	UKCoreAllergyManifestation https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation from this IG
AllergyIntolerance.reaction.severity	required	AllergyIntoleranceSeverity http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1 from the FHIR Standard
AllergyIntolerance.reaction.exposureRoute	preferred	UKCoreSubstanceOrProductAdministrationRoute https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
ait-1	error	AllergyIntolerance	AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. : verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()
ait-2	error	AllergyIntolerance	AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	AllergyIntolerance	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from UKCoreAllergyIntolerance

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance		0..*	UKCoreAllergyIntolerance	Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
identifier
system		1..1	uri	The namespace for the identifier value
value		1..1	string	The value that is unique
assigner		0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
clinicalStatus
id		0..0
verificationStatus		1..1	CodeableConcept	Defines the assertion of the allergy or intolerance.
type	S	1..1	code	allergy | intolerance - Underlying mechanism (if known)
category	S	0..*	code	food | medication | environment | biologic
criticality	S	0..1	code	low | high | unable-to-assess
code
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
patient		1..1	Reference(InterweavePatient)	Links the allergy or intolerance to the patient.
encounter		0..1	Reference(InterweaveEncounter)	Encounter when the allergy or intolerance was asserted
onset[x]	S	0..1		When allergy or intolerance was identified
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
recordedDate	S	1..1	dateTime	Date first version of the resource instance was recorded
recorder		0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Who recorded the sensitivity
asserter	S	0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Source of the information about the allergy
lastOccurrence		0..1	dateTime	DISCOURAGED - maybe misleading unless information is kept acutely up to date.
reaction
id		0..0
substance
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
onset	S	0..1	dateTime	Date(/time) when manifestations showed
exposureRoute
coding
system		1..1	uri	Identity of the terminology system
code		1..1	code	Symbol in syntax defined by the system
display		1..1	string	Representation defined by the system
note		0..0
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	UKCoreAllergyIntolerance	Allergy or Intolerance (generally: Risk of adverse reaction to a substance) ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
Slices for extension				Content/Rules for all slices
evidence		0..*	Reference(DiagnosticReport)	A reference to a DiagnosticReport resource for investigations that confirm the certainty of the allergy or intolerance diagnosis. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
clinicalStatus	?!SΣC	0..1	CodeableConcept	Defines whether the allergy or intolerance is active, inactive or resolved. Binding: AllergyIntoleranceClinicalStatusCodes (required): The clinical status of the allergy or intolerance.
Slices for extension				Content/Rules for all slices
allergyIntoleranceEnd		0..1	(Complex)	The date when the allergy or intolerance clinicalStatus is updated to inactive or resolved. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd
verificationStatus	?!SΣC	1..1	CodeableConcept	Defines the assertion of the allergy or intolerance. Binding: AllergyIntoleranceVerificationStatusCodes (required): Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
type	SΣ	1..1	code	allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category	SΣ	0..*	code	food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality	SΣ	0..1	code	low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code	SΣ	1..1	CodeableConcept	This code identifies the allergy or intolerance. Binding: UK Core Allergy Code (preferred)
patient	SΣ	1..1	Reference(InterweavePatient)	Links the allergy or intolerance to the patient.
encounter		0..1	Reference(InterweaveEncounter)	Encounter when the allergy or intolerance was asserted
onset[x]	S	0..1		When allergy or intolerance was identified
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
recordedDate	S	1..1	dateTime	Date first version of the resource instance was recorded
recorder		0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Who recorded the sensitivity
asserter	SΣ	0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Source of the information about the allergy
lastOccurrence		0..1	dateTime	DISCOURAGED - maybe misleading unless information is kept acutely up to date.
reaction	S	0..*	BackboneElement	Details about each adverse reaction event.
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event Binding: UK Core Allergy Manifestation (preferred)
onset	S	0..1	dateTime	Date(/time) when manifestations showed
severity	S	0..1	code	A clinical assessment of the severity of the reaction event as a whole. Binding: AllergyIntoleranceSeverity (required): Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
AllergyIntolerance.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
AllergyIntolerance.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
AllergyIntolerance.clinicalStatus	required	AllergyIntoleranceClinicalStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1 from the FHIR Standard
AllergyIntolerance.verificationStatus	required	AllergyIntoleranceVerificationStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1 from the FHIR Standard
AllergyIntolerance.type	required	AllergyIntoleranceType http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1 from the FHIR Standard
AllergyIntolerance.category	required	AllergyIntoleranceCategory http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1 from the FHIR Standard
AllergyIntolerance.criticality	required	AllergyIntoleranceCriticality http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1 from the FHIR Standard
AllergyIntolerance.code	preferred	UKCoreAllergyCode https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode from this IG
AllergyIntolerance.reaction.manifestation	preferred	UKCoreAllergyManifestation https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation from this IG
AllergyIntolerance.reaction.severity	required	AllergyIntoleranceSeverity http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
ait-1	error	AllergyIntolerance	AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. : verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()
ait-2	error	AllergyIntolerance	AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	AllergyIntolerance	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
AllergyIntolerance	C	0..*	UKCoreAllergyIntolerance	Allergy or Intolerance (generally: Risk of adverse reaction to a substance) ait-1: AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. ait-2: AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
evidence		0..*	Reference(DiagnosticReport)	A reference to a DiagnosticReport resource for investigations that confirm the certainty of the allergy or intolerance diagnosis. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Evidence
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	External ids for this item
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(InterweaveOrganization)	Organization that issued id (may be just text)
clinicalStatus	?!SΣC	0..1	CodeableConcept	Defines whether the allergy or intolerance is active, inactive or resolved. Binding: AllergyIntoleranceClinicalStatusCodes (required): The clinical status of the allergy or intolerance.
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
allergyIntoleranceEnd		0..1	(Complex)	The date when the allergy or intolerance clinicalStatus is updated to inactive or resolved. URL: https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AllergyIntoleranceEnd
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
verificationStatus	?!SΣC	1..1	CodeableConcept	Defines the assertion of the allergy or intolerance. Binding: AllergyIntoleranceVerificationStatusCodes (required): Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
type	SΣ	1..1	code	allergy | intolerance - Underlying mechanism (if known) Binding: AllergyIntoleranceType (required): Identification of the underlying physiological mechanism for a Reaction Risk.
category	SΣ	0..*	code	food | medication | environment | biologic Binding: AllergyIntoleranceCategory (required): Category of an identified substance associated with allergies or intolerances.
criticality	SΣ	0..1	code	low | high | unable-to-assess Binding: AllergyIntoleranceCriticality (required): Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
code	SΣ	1..1	CodeableConcept	This code identifies the allergy or intolerance. Binding: UK Core Allergy Code (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
patient	SΣ	1..1	Reference(InterweavePatient)	Links the allergy or intolerance to the patient.
encounter		0..1	Reference(InterweaveEncounter)	Encounter when the allergy or intolerance was asserted
onset[x]	S	0..1		When allergy or intolerance was identified
onsetDateTime			dateTime
onsetAge			Age
onsetPeriod			Period
recordedDate	S	1..1	dateTime	Date first version of the resource instance was recorded
recorder		0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Who recorded the sensitivity
asserter	SΣ	0..1	Reference(InterweavePatient | InterweaveRelatedPerson | InterweavePractitioner | InterweavePractitionerRole)	Source of the information about the allergy
lastOccurrence		0..1	dateTime	DISCOURAGED - maybe misleading unless information is kept acutely up to date.
note		0..*	Annotation	Additional text not captured in other fields
reaction	S	0..*	BackboneElement	Details about each adverse reaction event.
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
substance		0..1	CodeableConcept	Specific substance or pharmaceutical product considered to be responsible for event Binding: UK Core Allergy Substance (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
manifestation	S	1..*	CodeableConcept	Clinical symptoms/signs associated with the Event Binding: UK Core Allergy Manifestation (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
description		0..1	string	Description of the event as a whole
onset	S	0..1	dateTime	Date(/time) when manifestations showed
severity	S	0..1	code	A clinical assessment of the severity of the reaction event as a whole. Binding: AllergyIntoleranceSeverity (required): Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
exposureRoute		0..1	CodeableConcept	How the subject was exposed to the substance Binding: UK Core Substance Or Product Administration Route (preferred)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
AllergyIntolerance.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
AllergyIntolerance.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
AllergyIntolerance.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
AllergyIntolerance.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
AllergyIntolerance.identifier.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
AllergyIntolerance.clinicalStatus	required	AllergyIntoleranceClinicalStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-clinical|4.0.1 from the FHIR Standard
AllergyIntolerance.verificationStatus	required	AllergyIntoleranceVerificationStatusCodes http://hl7.org/fhir/ValueSet/allergyintolerance-verification|4.0.1 from the FHIR Standard
AllergyIntolerance.type	required	AllergyIntoleranceType http://hl7.org/fhir/ValueSet/allergy-intolerance-type|4.0.1 from the FHIR Standard
AllergyIntolerance.category	required	AllergyIntoleranceCategory http://hl7.org/fhir/ValueSet/allergy-intolerance-category|4.0.1 from the FHIR Standard
AllergyIntolerance.criticality	required	AllergyIntoleranceCriticality http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality|4.0.1 from the FHIR Standard
AllergyIntolerance.code	preferred	UKCoreAllergyCode https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyCode from this IG
AllergyIntolerance.reaction.substance	preferred	UKCoreAllergySubstance https://fhir.hl7.org.uk/ValueSet/UKCore-AllergySubstance from this IG
AllergyIntolerance.reaction.manifestation	preferred	UKCoreAllergyManifestation https://fhir.hl7.org.uk/ValueSet/UKCore-AllergyManifestation from this IG
AllergyIntolerance.reaction.severity	required	AllergyIntoleranceSeverity http://hl7.org/fhir/ValueSet/reaction-event-severity|4.0.1 from the FHIR Standard
AllergyIntolerance.reaction.exposureRoute	preferred	UKCoreSubstanceOrProductAdministrationRoute https://fhir.hl7.org.uk/ValueSet/UKCore-SubstanceOrProductAdministrationRoute from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
ait-1	error	AllergyIntolerance	AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error. : verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()
ait-2	error	AllergyIntolerance	AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error : verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()
dom-2	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	AllergyIntolerance	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	AllergyIntolerance	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	AllergyIntolerance	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from UKCoreAllergyIntolerance

Summary

Mandatory: 3 elements(20 nested mandatory elements)
Must-Support: 18 elements
Fixed: 2 elements
Prohibited: 8 elements

Structures

This structure refers to these other structures:

• InterweaveOrganization (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Organization)
• InterweavePatient (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Patient)
• InterweaveEncounter (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Encounter)
• InterweaveRelatedPerson (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-RelatedPerson)
• InterweavePractitioner (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Practitioner)
• InterweavePractitionerRole (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-PractitionerRole)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of AllergyIntolerance.meta.tag