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ref Template  IPS Allergy or Intolerance

Id 2.16.840.1.113883.10.22.4.1 Effective Date valid from 2016‑11‑10
Status draft Draft Version Label
Name IPSEntryAllergyOrIntolerance Display Name IPS Allergy or Intolerance
Description
This template reflects a discrete observation about a patient's allergy or intolerance.
Because it is a discrete observation, it will have a statusCode of "completed".
The effectiveTime, also referred to as the "biologically relevant time" is the time at which the observation holds for the patient.
For a provider seeing a patient in the clinic today, observing a history of penicillin allergy that developed five years ago, the effectiveTime is five years ago.
The effectiveTime of the Allergy - Intolerance Observation gives an indication of whether or not the underlying allergy/intolerance is resolved. If known to be resolved, then an effectiveTime/high would be present. 
If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of "UNK". 
It is recommended that the agent responsible for an allergy or adverse reaction would be used for describing the allergy, however the possibility that pre-coordinate codes (e.g. "allergy to nuts") will be used has been here also considered.
The agent responsible for  an allergy or adverse reaction it is not always a manufactured material (for example, food allergies), nor is it necessarily consumed; however  the playingEntity classCode = "MMAT" for all agents, manufactured or not is expected to be used. This choice depends on thecharacteristics of the base CDA R2 specification.
Context Parent nodes of template element with id 2.16.840.1.113883.10.22.4.1
Classification CDA Entry Level Template
Open/Closed Open (other than defined elements are allowed)
Used by / Uses
Used by 0 transactions and 3 templates, Uses 4 templates
Used by as Name Version
2.16.840.1.113883.10.22.4.5 Containment draft IPS Allergy and Intolerance Concern 2016‑11‑11
2.16.840.1.113883.10.22.3.2 link draft IPS Allergies and Intolerances Section 2016‑11‑11
2.16.840.1.113883.10.22.1.1 link draft International Patient Summary 2017‑04‑11
Uses as Name Version
2.16.840.1.113883.10.22.4.6 Containment draft IPS Reaction Manifestation DYNAMIC
2.16.840.1.113883.10.22.4.18 Containment draft IPS Criticality Observation DYNAMIC
2.16.840.1.113883.10.22.4.19 Containment draft IPS Certainty Observation DYNAMIC
2.16.840.1.113883.10.22.4.21 Containment draft IPS Allergy Status Observation DYNAMIC
Relationship Adaptation: template 2.16.840.1.113883.10.20.1.18 (DYNAMIC)
Adaptation: template 1.3.6.1.4.1.19376.1.5.3.1.4.5 (DYNAMIC)
Adaptation: template 1.3.6.1.4.1.19376.1.5.3.1.4.6 (DYNAMIC)
Example
Example
<observation classCode="OBS" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.1"/>  <id root=" " extension=" "/>  <!-- This is the code that shows what kind of allergy or intolerance -->
  <code code="X-AoI" displayName="Allergy or Intolerance" codeSystem="2.16.840.1.113883.3.1937.777.13.5.999.1"/>  <text>
    <reference value="#ref1"/>  </text>  <statusCode code="completed"/>  <effectiveTime>
    <low value="20170701"/>  </effectiveTime>  <!-- This is the allergen - the substance that caused the allergy -->
  <participant typeCode="CSM">
    <participantRole classCode="MANU">
      <playingEntity classCode="MMAT">
        <code code=" " codeSystem=" ">
          <originalText>
            <reference value="#substance"/>          </originalText>        </code>        <name>...</name>      </playingEntity>    </participantRole>  </participant>  <!-- This is how the allergy manifests itself -->
  <entryRelationship typeCode="MFST" inversionInd="true">
    <!-- template 2.16.840.1.113883.10.22.4.6 'IPS Reaction Manifestation' (dynamic) -->
  </entryRelationship>  <entryRelationship typeCode="SUBJ" inversionInd="true">
    <!-- template 2.16.840.1.113883.10.22.4.18 'IPS Criticality Observation' (dynamic) -->
  </entryRelationship>  <entryRelationship typeCode="SUBJ" inversionInd="true">
    <!-- template 2.16.840.1.113883.10.22.4.19 'IPS Certainty Observation' (dynamic) -->
  </entryRelationship>  <entryRelationship typeCode="REFR" inversionInd="false">
    <!-- template 2.16.840.1.113883.10.22.4.21 'IPS Allergy Status Observation' (dynamic) -->
  </entryRelationship></observation>
Example
No Known Allergies
<observation classCode="OBS" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.1"/>  <code code="allergy" displayName="Allergy" codeSystem="2.16.840.1.113883.4.642.1.122"/>  <statusCode code="completed"/>  <effectiveTime>
    <low nullFlavor="UNK"/>  </effectiveTime>  <value code="X-NoKnownAllergy" displayName="No known allergy" codeSystem="2.16.840.1.113883.3.1937.777.13.5.999.1"/></observation>
Example
No Information available about allergies or intolerances
<observation classCode="OBS" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.1"/>  <code code="X-AoI" displayName="Allergy or Intolerance" codeSystem="2.16.840.1.113883.3.1937.777.13.5.999.1"/>  <statusCode code="completed"/>  <effectiveTime>
    <low nullFlavor="NA"/>  </effectiveTime>  <value code="X-AllergicDispositionNotKnown" displayName="Allergic disposition not known" codeSystem="2.16.840.1.113883.3.1937.777.13.5.999.1"/></observation>
Example
Minimum Set (active propensity; agent known)
<observation classCode="OBS" moodCode="EVN">
  <templateId root="2.16.840.1.113883.10.22.4.1"/>  <code code="X-AoI" displayName="Allergy or Intolerance" codeSystem="2.16.840.1.113883.3.1937.777.13.5.999.1"/>  <statusCode code="completed"/>  <effectiveTime>
    <low nullFlavor="UNK"/>  </effectiveTime>  <participant typeCode="CSM">
    <participantRole classCode="MANU">
      <playingEntity classCode="MMAT">
        <code code="13577000" codeSystem="2.16.840.1.113883.6.96" displayName="Nut"/>      </playingEntity>    </participantRole>  </participant></observation>
notice There is an open issue with this item:
Item DT Card Conf Description Label
hl7:observation
 R (IPSdotsnce)
@classCode
 cs 1 … 1 F OBS
@moodCode
 cs 1 … 1 F EVN
hl7:templateId
 II 1 … 1 M (IPSdotsnce)
@root
 uid 1 … 1 F 2.16.840.1.113883.10.22.4.1
hl7:id
 II 0 … * R (IPSdotsnce)
hl7:code
 CD.IPS 1 … 1 M This element describes whether this condition refers to an allergy, non-allergy intolerance, or unknown class of intolerance (not known to be allergy or intolerance). (IPSdotsnce)
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.11.22.2 Allergy or Intolerance Type (DYNAMIC)
hl7:text
 ED 0 … 1 R The <text> element if present points to the text describing the problem being recorded; including any dates, comments, et cetera. The <reference> contains a URI in value attribute. This URI points to the free text description of the problem in the document that is being described. (IPSdotsnce)
hl7:reference
 TEL 1 … 1 M (IPSdotsnce)
@value
 1 … 1 R When used it shall refer to the narrative, typically #{label}-{generated-id}, e.g. #xxx-1
hl7:statusCode
 CS 1 … 1 M A clinical document normally records only those condition observation events that have been completed, not observations that are in any other state. Therefore, the shall always have code='completed'. (IPSdotsnce)
@code
 cs 1 … 1 F completed
hl7:effectiveTime
 IVL_TS 1 … 1 M The effectiveTime, also referred to as the "biologically relevant time" is the time at which the observation holds for the patient. For a provider seeing a patient in the clinic today, observing a history of penicillin allergy that developed five years ago, the effectiveTime is five years ago. The effectiveTime of the Allergy - Intolerance  Observation may give an indication of whether or not the underlying allergy/intolerance is resolved. 
The <low> and <high> values should be no more precise than known, but as precise as possible. 		(IPSdotsnce)
hl7:low
 IVXB_TS 1 … 1 R The effectiveTime/low (a.k.a. "onset date") asserts when the allergy/intolerance became biologically active. (IPSdotsnce)
hl7:high
 IVXB_TS 0 … 1 C The effectiveTime/high (a.k.a. "resolution date") asserts when the allergy/intolerance became biologically resolved.
If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of "UNK". 		(IPSdotsnce)
  Constraint If this condition is known to be resolved, then the effectiveTime/high would be present.
hl7:value
 CD.IPS preferred 0 … 1 C The coded form shall be used to indicate known absent conditions (e.g. NKA) or the nonavailability of infos about them; or in some cases the allergy to specific substances (e.g. allergy to nuts).
When the value is present in a coded form, no allergy agent is expected to be provided. 		(IPSdotsnce)
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.11.22.10 Allergies to substances (DYNAMIC)
or
The value of @code shall be drawn from value set 2.16.840.1.113883.11.22.9 Absent or Unknown Allergies (DYNAMIC)
hl7:participant
 0 … 1 C The substance that causes the allergy or intolerance should be specified in the <participant> structure. 
This is the preferred way an allergy is supposed to be expressed.
However it is recognized that in some contexts a controlled vocabulary is used for describing the allergy to a substance; or for asserting known absence or unavailability of information. 
In this case the <participant> structure shall be omitted.
The agent responsible for an allergy or adverse reaction is not always a manufactured material (for example, food allergies), nor is it necessarily consumed. The following constraints reflect limitations in the base CDA R2 specification, and should be used to represent any type of responsible agent, i.e., use playingEntity classCode = "MMAT" for all agents, manufactured or not. 		(IPSdotsnce)
@typeCode
 cs 1 … 1 F CSM
  Constraint IF the observation/value element is present and coded then the observation/participant element SHALL be omitted.
Conditional: Omit if Observation.value is SNOMED-CT 160244002 No known Allergies
hl7:participantRole
 0 … 1 C (IPSdotsnce)
@classCode
 cs 1 … 1 F MANU
hl7:playingEntity
 1 … 1 R (IPSdotsnce)
@classCode
 cs 1 … 1 F MMAT
hl7:code
 CD.IPS preferred 1 … 1 R Code for the substance causing the allergy or intolerance. (IPSdotsnce)
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.11.22.11 Adverse Reaction Agents (DYNAMIC)
  Schematron assert role red error  
  test hl7:value[@code] or hl7:participantRole  
  Message IF the observation/value element is present and coded then the observation/participant element SHALL be omitted  
  Schematron assert role red error  
  test hl7:value[@code] or hl7:participant/hl7:participantRole  
  Message IF the observation/value element is present and coded then the observation/participant element SHALL be omitted  
hl7:entryRelationship
 0 … * R The contained entry describes the reactions that are manifestations (typeCode='MFST') of the reported allergy or intolerance.
Contains 2.16.840.1.113883.10.22.4.6 IPS Reaction Manifestation (DYNAMIC) 		(IPSdotsnce)
treeblank where [@typeCode='MFST'] [hl7:observation [hl7:templateId [@root='2.16.840.1.113883.10.22.4.6']]]
@typeCode
 cs 1 … 1 F MFST
@inversionInd
 cs 1 … 1 F true
hl7:entryRelationship
 0 … 1 R Criticality
The contained entry describes the gravity of the potential risk for future life-threatening adverse reactions when exposed to a substance known to cause an adverse reaction in that individual.
Contains 2.16.840.1.113883.10.22.4.18 IPS Criticality Observation (DYNAMIC) 		(IPSdotsnce)
treeblank where [@typeCode='SUBJ'] [hl7:observation [hl7:templateId [@root='2.16.840.1.113883.10.22.4.18']]]
@typeCode
 cs 1 … 1 F SUBJ
@inversionInd
 cs 1 … 1 F true
hl7:entryRelationship
 0 … 1 R Certainty or Verification Status
The contained entry describes the certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
Contains 2.16.840.1.113883.10.22.4.19 IPS Certainty Observation (DYNAMIC) 		(IPSdotsnce)
treeblank where [@typeCode='SUBJ'] [hl7:observation [hl7:templateId [@root='2.16.840.1.113883.10.22.4.19']]]
@typeCode
 cs 1 … 1 F SUBJ
@inversionInd
 cs 1 … 1 F true
hl7:entryRelationship
 0 … 1 R Status of the Allergy or Intolerance 
The contained entry describes the current status of the allergy or intolerance, for example, whether it is active, in remission, resolved, and so on ...
Contains 2.16.840.1.113883.10.22.4.21 IPS Allergy Status Observation (DYNAMIC) 		(IPSdotsnce)
treeblank where [@typeCode='REFR'] [hl7:observation [hl7:templateId [@root='2.16.840.1.113883.10.22.4.21'] and hl7:templateId [@root='2.16.840.1.113883.10.22.4.20']]]
@typeCode
 cs 1 … 1 F REFR
@inversionInd
 cs 1 … 1 F false