AllergyIntolerance

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

 

Response Description

Sample Response

{

  "resourceType": "AllergyIntolerance",

  "id": "DEV-DEV-11913-4648",

  "meta": {

     "lastUpdated": "2022-11-08T12:00:00-05:00",

     "profile": [

        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance"

     ]

  },

  "text": {

     "status": "generated",

     "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table><tbody><tr><td>Patient:</td><td>Cole Andersonian (DEV-DEV-11913)</td></tr><tr><td>Encounter:</td><td>accountLevel</td></tr><tr><td></td></tr><tr><td>Status:</td><td>active</td></tr><tr><td>Allergen:</td><td>Peanuts (RxNorm code 891658)</td></tr><tr><td>Reaction:</td><td>Swelling</td></tr><tr><td>Reaction Severity:</td><td>severe</td></tr><tr><td>Onset Date</td><td>05/08/2002</td></tr><tr><td></td></tr><tr><td>Recorded Date:</td><td>11/08/2022</td></tr><tr><td>Recorder:</td><td>gvtadaws</td></tr></tbody></table></div>"

  },

  "verificationStatus": {

     "coding": [

        {

           "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",

           "code": "unconfirmed",

           "display": "Unconfirmed"

        }

     ]

  },

  "clinicalStatus": {

     "coding": [

        {

           "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",

           "code": "active",

           "display": "active"

        }

     ]

  },

  "criticality": "high",

  "code": {

     "coding": [

        {

           "system": "http://www.nlm.nih.gov/research/umls/rxnorm",

           "code": "891658",

           "display": "Peanuts"

        }

     ],

     "text": "Peanuts"

  },

  "patient": {

     "reference": "Patient/DEV-DEV-11913",

     "display": "Cole Andersonian (DEV-DEV-11913)"

  },

  "recordedDate": "2022-11-08",

  "onsetDateTime": "2022-11-08",

  "recorder": {

     "reference": "Practitioner/GVTADAWS"

  },

  "reaction": [

     {

        "manifestation": [

           {

              "coding": [

                 {

                    "system": "http://snomed.info/sct",

                    "code": "65124004",

                    "display": "Swelling (finding)"

                 }

              ]

           }

        ],

        "severity": "severe",

        "description": "Swelling"

     }

  ]

}

 

AllergyIntolerance.id

 

The internal id of the individual allergy. Once assigned, this value never changes.

Cardinality

0..1

Type

string

 

 

AllergyIntolerance.meta

 

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.

Cardinality

0..1

Type

Meta

 

 

AllergyIntolerance.text

 

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.

Cardinality

0..1

Type

Narrative

Comment

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.

 

 

AllergyIntolerance.verificationStatus

 

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

Cardinality

0..1

Type

CodeableConcept. The codes SHALL be taken from AllergyIntoleranceVerificationStatusCodes

Comment

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.

 

 

AllergyIntolerance.clinicalStatus

 

The clinical status of the allergy or intolerance.

Cardinality

0..1

Type

CodeableConcept. The codes will be one of: active | inactive

Comment

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.

 

 

AllergyIntolerance.criticality

 

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

Cardinality

0..1

Type

code. The codes SHALL be taken from AllergyIntoleranceCriticality

Comment

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.

 

 

AllergyIntolerance.code

 

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").

Cardinality

1..1

Type

CodeableConcept. The codes SHALL be taken from US Core Common substances for allergy and intolerance documentation including refutations

Comment

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.

 

 

AllergyIntolerance.patient

 

A reference to the Patient resource for the patient who has the allergy or intolerance.

Cardinality

1..1

Type

Reference(USCorePatientProfile)

 

 

AllergyIntolerance.encounter

 

A reference to the encounter when the allergy or intolerance was asserted.

Cardinality

0..1

Type

Reference(Encounter)

 

 

AllergyIntolerance.recordedDate

 

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

Cardinality

0..*

Type

DateTime

 

 

AllergyIntolerance.onsetDateTime

 

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

Cardinality

0..*

Type

DateTime

 

 

AllergyIntolerance.recorder

 

Who recorded the Condition

Cardinality

0..1

Type

Reference(USCorePractitionerProfile)

 

 

AllergyIntolerance.reaction

 

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

Cardinality

0..*

Type

BackboneElement

 

 

AllergyIntolerance.reaction.manifestation

 

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

Cardinality

1..*

Type

CodeableConcept. The codes SHALL be taken from SNOMEDCTClinicalFindings

Comment

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.

 

 

AllergyIntolerance.reaction.severity

 

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

Cardinality

0..1

Type

code. The codes SHALL be taken from AllergyIntoleranceSeverity

Comment

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.

 

 

AllergyIntolerance.reaction.description

 

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

Cardinality

0..1

Type

string

Comment

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.

 


 

Search

 

URL Syntax

Two HTTP methods are supported for searching: GET and POST. It is recommended to use HTTP POST.

Visit the FHIR Sandbox to try requests.

 

 

HTTP GET - searching

https://sandbox.pai.healthcare/preview/fhir/AllergyIntolerance?{query string}

 

HTTP GET - return single record

https://sandbox.pai.healthcare/preview/fhir/AllergyIntolerance/{resource id}

 

HTTP POST - searching

https://sandbox.pai.healthcare/preview/fhir/AllergyIntolerance/_search

Set the Content-Type header to application/x-www-urlencoded

The body of the request is a similar query string used in the GET type of request detailed above.

 

 

Error Handling

If no records are returned or invalid search parameters are provided, then an HTTP 400 Bad Request is returned.

The body of the response will be an OperationOutcome.

 

 

Supported Search Parameters

 

_id

Corresponds to

AllergyIntolerance.id

Search

exact

Example

https://sandbox.pai.healthcare/preview/fhir/AllergyIntolerance/dev-DEV-test-234234

https://sandbox.pai.healthcare/preview/fhir/AllergyIntolerance?_id=dev-DEV-test-234234

 

 

Returns the clinicalAllergy resource for the test account in the dev practice where clinicalAllergyTableID is 234234.

 

patient

Corresponds to

AllergyIntolerance.patient

Search

exact

Example

https://sandbox.pai.healthcare/preview/fhir/AllergyIntolerance?patient=Patient/dev-dev-test

 

Returns all allergies for the test account in the dev practice

 

encounter

Corresponds to

AllergyIntolerance.encounter

Search

exact

Example

https://sandbox.pai.healthcare/preview/fhir/AllergyIntolerance?encounter=Encounter/0044433

 

Returns all clinical allergies entered for the encounter with accession# 0044433

 

name

Corresponds to

AllergyIntolerance.code.text

Search

contains

Example

https://sandbox.pai.healthcare/preview/fhir/AllergyIntolerance?name=aspirin

 

Returns all clinical allergies entered where the allergen name matches aspirin