AllergyIntolerance/example

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<AllergyIntolerance xmlns="http://hl7.org/fhir">
  <id value="example"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: example</p><p><b>meta</b>: </p><p><b>identifier</b>: 49476534</p><p><b>clinicalStatus</b>: Active <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical code 'active' = 'Active)</span></p><p><b>verificationStatus</b>: Confirmed <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/allergyintolerance-verification code 'confirmed' = 'Confirmed)</span></p><p><b>type</b>: allergy</p><p><b>category</b>: food</p><p><b>criticality</b>: high</p><p><b>code</b>: Cashew nuts <span style="background: LightGoldenRodYellow">(Details : {SNOMED CT code '227493005' = 'Cashew nuts', given as 'Cashew nuts'})</span></p><p><b>patient</b>: <a href="Patient-example.html">Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 1974-12-25; </a></p><p><b>onset</b>: Jan 1, 2004 12:00:00 AM</p><p><b>recordedDate</b>: Oct 9, 2014 3:58:00 AM</p><p><b>recorder</b>: <a href="Practitioner-example.html">Generated Summary: id: example; 23; active; Adam Careful </a></p><p><b>asserter</b>: <a href="Patient-example.html">Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 1974-12-25; </a></p><p><b>lastOccurrence</b>: Jun 2, 2012 1:45:31 AM</p><p><b>note</b>: The criticality is high becasue of the observed anaphylactic reaction when challenged     with cashew extract.</p><blockquote><p><b>reaction</b></p><p><b>substance</b>: cashew nut allergenic extract Injectable Product <span style="background: LightGoldenRodYellow">(Details : {RxNorm code '1160593' = 'cashew nut allergenic extract Injectable Product', given as 'cashew nut allergenic extract Injectable Product'})</span></p><p><b>manifestation</b>: Anaphylactic reaction <span style="background: LightGoldenRodYellow">(Details : {SNOMED CT code '39579001' = 'Anaphylaxis', given as 'Anaphylactic reaction'})</span></p><p><b>description</b>: Challenge Protocol. Severe reaction to subcutaneous cashew extract. Epinephrine administered</p><p><b>onset</b>: Jun 12, 2012 12:00:00 AM</p><p><b>severity</b>: severe</p><p><b>exposureRoute</b>: Subcutaneous route <span style="background: LightGoldenRodYellow">(Details : {SNOMED CT code '34206005' = 'Subcutaneous route', given as 'Subcutaneous route'})</span></p></blockquote><blockquote><p><b>reaction</b></p><p><b>manifestation</b>: Urticaria <span style="background: LightGoldenRodYellow">(Details : {SNOMED CT code '64305001' = 'Urticaria', given as 'Urticaria'})</span></p><p><b>onset</b>: Jan 1, 2004 12:00:00 AM</p><p><b>severity</b>: moderate</p><p><b>note</b>: The patient reports that the onset of urticaria was within 15 minutes of eating cashews.</p></blockquote></div>
  </text>
<!--     an identifier used for this allergic propensity (adverse reaction risk)     -->
  <identifier>
    <system value="http://acme.com/ids/patients/risks"/>
    <value value="49476534"/>
  </identifier>
<!--     this individual has had several reactions     -->
  <clinicalStatus>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical"/>
      <code value="active"/>
    </coding>
  </clinicalStatus>
  <verificationStatus>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/allergyintolerance-verification"/>
      <code value="confirmed"/>
    </coding>
  </verificationStatus>
<!--     note: it's often unknown whether an allergy is mediated by an immune response, and
   not as significant as once thought     -->
  <type value="allergy"/>
<!--     this categorisation is implied by "cashew nut" and therefore basically 
    redundant, but many systems collect this field anyway, since it's either 
    useful when the substance is not coded, or it's quicker to sort/filter on
    than using terminology based reasoning     -->
  <category value="food"/>
<!--     there is no question that the allergy is real and serious     -->
  <criticality value="high"/>
<!--     Allergy or intolerance code (substance, product, condition or negated/excluded statement)
   or text. A few times, 
    there's a full description of a complex substance/product - in these caes, use the
    extension [url] to refer to a Substance resource.     -->
  <code>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="227493005"/>
      <display value="Cashew nuts"/>
    </coding>
  </code>
<!--     the patient that actually has the risk of adverse reaction     -->
  <patient>
    <reference value="Patient/example"/>
  </patient>
<!--     when the allergy was first noted (in this case the same as reaction.onset of the first
   occurrence)     -->
  <onsetDateTime value="2004"/>
<!--     the date that this entry was recorded     -->
  <recordedDate value="2014-10-09T14:58:00+11:00"/>
<!--     who made the record / last updated it     -->
  <recorder>
    <reference value="Practitioner/example"/>
  </recorder>
<!--     the patient is the reporter in this case     -->
  <asserter>
    <reference value="Patient/example"/>
  </asserter>
<!--     last happened June 2012. Typically, systems either track lastOccurrence,
     or a list of events.     -->
  <lastOccurrence value="2012-06-02T01:45:31+00:00"/>
<!--     an additional note about the allergy propensity by the recorder     -->
  <note>
    <text
          value="The criticality is high becasue of the observed anaphylactic reaction when challenged     with cashew extract."/>
  </note>
<!--     past events. There's no claim that this is all the events, and 
     that should not be assumed     -->
  <reaction>
  <!--     
      It's possible to list specific things to which the patient responded,
      e.g. chocolate (that happened to contain cashew nuts). This event has
      such a specific substance. Note that systems should ensure that what
      goes in here does not conflict with the substance above, and systems
      processing the data can be sure that what is here does not contravene
      the substance above
        -->
    <substance>
      <coding>
        <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
        <code value="1160593"/>
        <display value="cashew nut allergenic extract Injectable Product"/>
      </coding>
    </substance>
    <manifestation>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="39579001"/>
        <display value="Anaphylactic reaction"/>
      </coding>
    </manifestation>
    <description
                 value="Challenge Protocol. Severe reaction to subcutaneous cashew extract. Epinephrine administered"/>
    <onset value="2012-06-12"/>
    <severity value="severe"/>
    <exposureRoute>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="34206005"/>
        <display value="Subcutaneous route"/>
      </coding>
    </exposureRoute>
  </reaction>
<!--     this was the first occurrence     -->
  <reaction>
    <manifestation>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="64305001"/>
        <display value="Urticaria"/>
      </coding>
    </manifestation>
    <onset value="2004"/>
    <severity value="moderate"/>
  <!--     an additional note about the reaction by the recorder     -->
    <note>
      <text
            value="The patient reports that the onset of urticaria was within 15 minutes of eating cashews."/>
    </note>
  </reaction>
</AllergyIntolerance>