StructureDefinition: DAF-AllergyIntolerance - XML

DAF-AllergyIntolerance

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="daf-allergyintolerance"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">to do</div>
  </text>
  <url value="http://hl7.org/fhir/StructureDefinition/daf-allergyintolerance"/>
  <name value="U.S. Data Access Framework (DAF) AllergyIntolerance Profile"/>
  <display value="DAF-AllergyIntolerance"/>
  <status value="draft"/>
  <publisher value="Health Level Seven International (Infrastructure and Messaging - Data Access Framework)"/>
  <contact>
    <telecom>
      <system value="other"/>
      <value value="http://www.healthit.gov"/>
    </telecom>
  </contact>
  <date value="2014-08-21"/>
  <description value="Defines constraints and extensions on the AllergyIntolerance resource for use in querying
   and retrieving allergy information."/>
  <fhirVersion value="1.2.0"/>
  <kind value="resource"/>
  <constrainedType value="AllergyIntolerance"/>
  <abstract value="false"/>
  <base value="http://hl7.org/fhir/StructureDefinition/AllergyIntolerance"/>
  <snapshot>
    <element>
      <path value="AllergyIntolerance"/>
      <name value="DAF-AllergyIntolerance"/>
      <short value="Allergy or Intolerance (generally: Risk Of Adverse reaction to a substance)"/>
      <definition value="Risk of harmful or undesirable, physiological response which is unique to an individual
       and associated with exposure to a substance."/>
      <comments value="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."/>
      <alias value="Allergy"/>
      <alias value="Intolerance"/>
      <alias value="Adverse Reaction"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="AllergyIntolerance"/>
      </type>
      <mapping>
        <identity value="w5"/>
        <map value="clinical.general"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.id"/>
      <short value="Logical id of this artifact"/>
      <definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this
       value never changes."/>
      <comments value="The only time that a resource does not have an id is when it is being submitted to the
       server using a create operation. Bundles always have an id, though it is usually a generated
       UUID."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.meta"/>
      <short value="Metadata about the resource"/>
      <definition value="The metadata about the resource. This is content that is maintained by the infrastructure.
       Changes to the content may not always be associated with version changes to the resource."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.meta"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Meta"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.implicitRules"/>
      <short value="A set of rules under which this content was created"/>
      <definition value="A reference to a set of rules that were followed when the resource was constructed, and
       which must be understood when processing the content."/>
      <comments value="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 as much as possible."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.implicitRules"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="uri"/>
      </type>
      <isModifier value="true"/>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.language"/>
      <short value="Language of the resource content"/>
      <definition value="The base language in which the resource is written."/>
      <comments value="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)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.language"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <binding>
        <strength value="required"/>
        <description value="A human language."/>
        <valueSetUri value="http://tools.ietf.org/html/bcp47"/>
      </binding>
    </element>
    <element>
      <path value="AllergyIntolerance.text"/>
      <short value="Text summary of the resource, for human interpretation"/>
      <definition value="A human-readable narrative that contains a summary of the resource, and may 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 &quot;clinically
       safe&quot; for a human to just read the narrative. Resource definitions may define what
       content should be represented in the narrative to ensure clinical safety."/>
      <comments value="Contained resources do not have narrative. Resources that are not contained SHOULD have
       a narrative."/>
      <alias value="narrative"/>
      <alias value="html"/>
      <alias value="xhtml"/>
      <alias value="display"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.text"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Narrative"/>
      </type>
      <condition value="dom-1"/>
      <mapping>
        <identity value="rim"/>
        <map value="Act.text?"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.contained"/>
      <short value="Contained, inline Resources"/>
      <definition value="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."/>
      <comments value="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."/>
      <alias value="inline resources"/>
      <alias value="anonymous resources"/>
      <alias value="contained resources"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance.contained"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Resource"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.extension"/>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the resource. In order 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."/>
      <comments value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="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.
       Usually modifier elements provide negation or qualification. In order 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."/>
      <comments value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.identifier"/>
      <short value="External ids for this item"/>
      <definition value="This records identifiers associated with this allergy/intolerance concern that are defined
       by business processes and/or used to refer to it when a direct URL reference to the resource
       itself is not appropriate (e.g. in CDA documents, or in written / printed documentation)."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance.identifier"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Identifier"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="IAM-7"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".id"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="id"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.onset"/>
      <short value="Date(/time) when manifestations showed"/>
      <definition value="Record of the date and/or time of the onset of the Allergy or Intolerance."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.onset"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.recordedDate"/>
      <short value="When recorded"/>
      <definition value="Date when the sensitivity was recorded."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.recordedDate"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="IAM-20"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=AUT].time"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="when.recorded"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.recorder"/>
      <short value="Who recorded the sensitivity"/>
      <definition value="Individual who recorded the record and takes responsibility for its conten."/>
      <alias value="Author"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.recorder"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-pract"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-patient"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=AUT].role"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="who.author"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.patient"/>
      <short value="Who the sensitivity is for"/>
      <definition value="The patient who has the allergy or intolerance."/>
      <alias value="Patient"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.patient"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-patient"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="(PID-3)"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <map value=".participation[typeCode=SBJ].role[classCode=PAT]"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="who.focus"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.reporter"/>
      <short value="Source of the information about the allergy"/>
      <definition value="The source of the information about the allergy that is recorded."/>
      <comments value="The recorder takes repsonsibility for the content, but can reference the source from where
       they got it."/>
      <alias value="Source"/>
      <alias value="Informant"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reporter"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-pract"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-relatedperson"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <mapping>
        <identity value="v2"/>
        <map value="IAM-14 (if patient) / IAM-18 (if practitioner)"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="who.source"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.substance"/>
      <short value="Substance, (or class) considered to be responsible for risk"/>
      <definition value="Identification of a substance, or a class of substances, that is considered to be responsible
       for the adverse reaction risk."/>
      <comments value="It is strongly recommended that the substance be coded with a terminology, where possible.
       For example, some terminologies used include RxNorm, SNOMED CT, DM+D, NDFRT, ICD-9, IDC-10,
       UNI, ATC and CPT. Plain text should only be used if there is no appropriate terminology
       available. Additional details about a substance can be specified in the text."/>
      <alias value="Agent"/>
      <min value="1"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.substance"/>
        <min value="1"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="preferred"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/daf-substance"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="AL1-3 / IAM-3"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="what"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.status"/>
      <short value="active | unconfirmed | confirmed | inactive | resolved | refuted | entered-in-error"/>
      <definition value="Assertion about certainty associated with the propensity, or potential risk, of a reaction
       to the identified Substance."/>
      <comments value="Decision support would typically raise alerts for 'Unconfirmed', 'Confirmed', and 'Resolved'
       and ignore a 'Refuted' reaction. In particular, 'Refuted' may be useful for reconciliation
       of the Adverse Reaction List. Some implementations may choose to make this field mandatory."/>
      <alias value="State"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.status"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <isModifier value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="Assertion about certainty associated with a propensity, or potential risk, of a reaction
         to the identified Substance."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/allergy-intolerance-status"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="IAM-17"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="status"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.criticality"/>
      <short value="CRITL | CRITH | CRITU"/>
      <definition value="Estimate of the potential clinical harm, or seriousness, of the reaction to the identified
       Substance."/>
      <comments value="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)."/>
      <alias value="Severity"/>
      <alias value="Seriousness"/>
      <alias value="Contra-indication"/>
      <alias value="Risk"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.criticality"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="Estimate of the potential clinical harm, or seriousness, of a reaction to an identified
         Substance."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/allergy-intolerance-criticality"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="w5"/>
        <map value="grade"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.type"/>
      <short value="allergy | intolerance - Underlying mechanism (if known)"/>
      <definition value="Identification of the underlying physiological mechanism for the reaction risk."/>
      <comments value="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 may not be in a position to distinguish the mechanism of a particular reaction.
       Often the term &quot;allergy&quot; is used rather generically and may overlap with the
       use of &quot;intolerance&quot; - in practice the boundaries between these two concepts
       may 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."/>
      <alias value="Category"/>
      <alias value="Class"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.type"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="Identification of the underlying physiological mechanism for a Reaction Risk."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/allergy-intolerance-type"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="v2"/>
        <map value="IAM-9"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <map value="class"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.category"/>
      <short value="food | medication | environment | other - Category of Substance"/>
      <definition value="Category of the identified Substance."/>
      <comments value="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."/>
      <alias value="Category"/>
      <alias value="Type"/>
      <alias value="Reaction Type"/>
      <alias value="Class"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.category"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="Category of an identified Substance."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/allergy-intolerance-category"/>
        </valueSetReference>
      </binding>
      <mapping>
        <identity value="w5"/>
        <map value="class"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.lastOccurence"/>
      <short value="Date(/time) of last known occurrence of a reaction"/>
      <definition value="Represents the date and/or time of the last known occurrence of a reaction event."/>
      <comments value="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."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.lastOccurence"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.note"/>
      <short value="Additional text not captured in other fields"/>
      <definition value="Additional narrative about the propensity for the Adverse Reaction, not captured in other
       fields."/>
      <comments value="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."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.note"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Annotation"/>
      </type>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction"/>
      <short value="Adverse Reaction Events linked to exposure to substance"/>
      <definition value="Details about each adverse reaction event linked to exposure to the identified Substance."/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance.reaction"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="BackboneElement"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.id"/>
      <representation value="xmlAttr"/>
      <short value="xml:id (or equivalent in JSON)"/>
      <definition value="unique id for the element within a resource (for internal references)."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reaction.id"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="id"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.extension"/>
      <short value="Additional Content defined by implementations"/>
      <definition value="May be used to represent additional information that is not part of the basic definition
       of the element. In order 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."/>
      <comments value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance.reaction.extension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <mapping>
        <identity value="rim"/>
        <map value="n/a"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.modifierExtension"/>
      <short value="Extensions that cannot be ignored"/>
      <definition value="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 that contains it. Usually
       modifier elements provide negation or qualification. In order 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."/>
      <comments value="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."/>
      <alias value="extensions"/>
      <alias value="user content"/>
      <alias value="modifiers"/>
      <min value="0"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance.reaction.modifierExtension"/>
        <min value="0"/>
        <max value="*"/>
      </base>
      <type>
        <code value="Extension"/>
      </type>
      <isModifier value="true"/>
      <mapping>
        <identity value="rim"/>
        <map value="N/A"/>
      </mapping>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.substance"/>
      <short value="Specific substance considered to be responsible for event"/>
      <definition value="Identification of the specific substance considered to be responsible for the Adverse
       Reaction event. Note: the substance for a specific reaction may be different to the substance
       identified as the cause of the risk, but must be consistent with it. For instance, it
       may be a more specific substance (e.g. a brand medication) or a composite substance that
       includes the identified substance. It must be clinically safe to only process the AllergyIntolerance
      .substance and ignore the AllergyIntolerance.event.substance."/>
      <comments value="Coding of the specific substance with a terminology capable of triggering decision support
       should be used wherever possible.  The substance field allows for the use of a specific
       substance or a group or class of substances, for example &quot;Penicillins&quot;. The
       specific substance field could be used for Amoxycillin. Duplication is acceptable when
       a specific substance has been recorded in the 'substance' field."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reaction.substance"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="preferred"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/daf-substance"/>
        </valueSetReference>
      </binding>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.certainty"/>
      <short value="unlikely | likely | confirmed - clinical certainty about the specific substance"/>
      <definition value="Statement about the degree of clinical certainty that the specific substance was the cause
       of the manifestation in this reaction event."/>
      <alias value="Cause"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reaction.certainty"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="Statement about the degree of clinical certainty that a Specific Substance was the cause
         of the Manifestation in an reaction event."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/reaction-event-certainty"/>
        </valueSetReference>
      </binding>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.manifestation"/>
      <short value="Clinical symptoms/signs associated with the Event"/>
      <definition value="Clinical symptoms and/or signs that are observed or associated with the adverse reaction
       event."/>
      <comments value="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."/>
      <alias value="Symptoms"/>
      <alias value="Signs"/>
      <min value="1"/>
      <max value="*"/>
      <base>
        <path value="AllergyIntolerance.reaction.manifestation"/>
        <min value="1"/>
        <max value="*"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <isSummary value="true"/>
      <binding>
        <strength value="preferred"/>
        <description value="Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction
         Event"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/daf-manifestation-ccda-codes"/>
        </valueSetReference>
      </binding>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.description"/>
      <short value="Description of the event as a whole"/>
      <definition value="Text description about the reaction as a whole, including details of the manifestation
       if required."/>
      <comments value="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."/>
      <alias value="Narrative"/>
      <alias value="Text"/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reaction.description"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="string"/>
      </type>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.onset"/>
      <short value="Date(/time) when manifestations showed"/>
      <definition value="Record of the date and/or time of the onset of the Reaction."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reaction.onset"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="dateTime"/>
      </type>
      <isSummary value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.severity"/>
      <short value="mild | moderate | severe (of event as a whole)"/>
      <definition value="Clinical assessment of the severity of the reaction event as a whole, potentially considering
       multiple different manifestations."/>
      <comments value="It is acknowledged that this assessment is very subjective. There may be some some specific
       practice domains where objective scales have been applied. Objective scales can be included
       in this model as extensions."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reaction.severity"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="code"/>
      </type>
      <isSummary value="true"/>
      <binding>
        <strength value="required"/>
        <description value="Clinical assessment of the severity of a reaction event as a whole, potentially considering
         multiple different manifestations."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/reaction-event-severity"/>
        </valueSetReference>
      </binding>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.exposureRoute"/>
      <short value="How the subject was exposed to the substance"/>
      <definition value="Identification of the route by which the subject was exposed to the substance."/>
      <comments value="Coding of the route of exposure with a terminology should be used wherever possible."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reaction.exposureRoute"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <isSummary value="true"/>
      <binding>
        <strength value="example"/>
        <description value="A coded concept describing the route or physiological path of administration of a therapeutic
         agent into or onto the body of a subject."/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/route-codes"/>
        </valueSetReference>
      </binding>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.note"/>
      <short value="Text about event not captured in other fields"/>
      <definition value="Additional text about the adverse reaction event not captured in other fields."/>
      <comments value="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."/>
      <min value="0"/>
      <max value="1"/>
      <base>
        <path value="AllergyIntolerance.reaction.note"/>
        <min value="0"/>
        <max value="1"/>
      </base>
      <type>
        <code value="Annotation"/>
      </type>
    </element>
  </snapshot>
  <differential>
    <element>
      <path value="AllergyIntolerance"/>
      <name value="DAF-AllergyIntolerance"/>
      <min value="0"/>
      <max value="*"/>
      <type>
        <code value="AllergyIntolerance"/>
      </type>
    </element>
    <element>
      <path value="AllergyIntolerance.identifier"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.onset"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.recordedDate"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.recorder"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-pract"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-patient"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.patient"/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-patient"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.reporter"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-pract"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-patient"/>
      </type>
      <type>
        <code value="Reference"/>
        <profile value="http://hl7.org/fhir/StructureDefinition/daf-relatedperson"/>
      </type>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.substance"/>
      <min value="1"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <strength value="preferred"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/daf-substance"/>
        </valueSetReference>
      </binding>
    </element>
    <element>
      <path value="AllergyIntolerance.status"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.criticality"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.category"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction"/>
      <mustSupport value="true"/>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.substance"/>
      <min value="0"/>
      <max value="1"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <strength value="preferred"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/daf-substance"/>
        </valueSetReference>
      </binding>
    </element>
    <element>
      <path value="AllergyIntolerance.reaction.manifestation"/>
      <min value="1"/>
      <max value="*"/>
      <type>
        <code value="CodeableConcept"/>
      </type>
      <mustSupport value="true"/>
      <binding>
        <strength value="preferred"/>
        <description value="Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction
         Event"/>
        <valueSetReference>
          <reference value="http://hl7.org/fhir/ValueSet/daf-manifestation-ccda-codes"/>
        </valueSetReference>
      </binding>
    </element>
  </differential>
</StructureDefinition>