2.16.840.1.113883.10.22.4.1/static-2016-11-10T000000

Id	2.16.840.1.113883.10.22.4.1	Effective Date	2016‑11‑10
Status	Under pre-publication review	Version Label	STU1
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)
Associated with	Associated with 12 concepts Id Name Data Set hl7ips-data​element-188  End Date  CEN/TC 251 prEN 17269 hl7ips-data​element-173  Agent  CEN/TC 251 prEN 17269 hl7ips-data​element-191  Type of propensity  CEN/TC 251 prEN 17269 hl7ips-data​element-196  Agent code  CEN/TC 251 prEN 17269 hl7ips-data​element-189  Criticality  CEN/TC 251 prEN 17269 hl7ips-data​element-182  Allergies/Intolerances Content Status  CEN/TC 251 prEN 17269 hl7ips-data​element-187  Onset date  CEN/TC 251 prEN 17269 hl7ips-data​element-190  Certainty  CEN/TC 251 prEN 17269 hl7ips-data​element-184  Allergy/Intolerance  CEN/TC 251 prEN 17269 hl7ips-data​element-185  Diagnosis  CEN/TC 251 prEN 17269 hl7ips-data​element-186  Clinical Status  CEN/TC 251 prEN 17269 hl7ips-data​element-192  Reaction  CEN/TC 251 prEN 17269
Uses	Uses 4 templates Uses as Name Version 2.16.840.1.113883.10.22.4.6 Containment IPS Reaction Manifestation (STU1) DYNAMIC 2.16.840.1.113883.10.22.4.18 Containment IPS Criticality Observation (STU1) DYNAMIC 2.16.840.1.113883.10.22.10 Containment IPS Allergy Certainty Observation (STU1) DYNAMIC 2.16.840.1.113883.10.22.4.21 Containment IPS Allergy Status Observation (STU1) 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="OINT" displayName="Allergy or Intolerance" codeSystem="2.16.840.1.113883.5.4"/>  <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="2.16.840.1.113883.5.1150.2"/></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="OINT" displayName="Allergy or Intolerance" codeSystem="2.16.840.1.113883.5.4"/>  <statusCode code="completed"/>  <effectiveTime>     <low nullFlavor="NA"/>  </effectiveTime>  <value code="no-allergy-info" displayName="No information about allergies" codeSystem="2.16.840.1.113883.5.1150.1"/></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="OINT" displayName="Allergy or Intolerance" codeSystem="2.16.840.1.113883.5.4"/>  <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>
Item DT Card Conf Description Label hl7:observation R (IPS...nce)   hl7ips-data​element-184  Allergy/Intolerance  CEN/TC 251 prEN 17269 @classCode cs 1 … 1 F OBS @moodCode cs 1 … 1 F EVN hl7:templateId II 1 … 1 M (IPS...nce) @root uid 1 … 1 F 2.16.840.1.113883.10.22.4.1 hl7:id II 0 … * R (IPS...nce) 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). (IPS...nce)   hl7ips-data​element-191  Type of propensity  CEN/TC 251 prEN 17269   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.</reference> (IPS...nce) hl7:reference TEL 1 … 1 M (IPS...nce) @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 <statusCode> shall always have code='completed'.</statusCode> (IPS...nce) @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. (IPS...nce) hl7:low IVXB_TS 1 … 1 R The effectiveTime/low (a.k.a. "onset date") asserts when the allergy/intolerance became biologically active. (IPS...nce)   hl7ips-data​element-187  Onset date  CEN/TC 251 prEN 17269 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". (IPS...nce)   hl7ips-data​element-188  End Date  CEN/TC 251 prEN 17269   Constraint If this condition is known to be resolved, then the effectiveTime/high would be present. Choice 0 … 1 The coded form of the observation value can be used : either to indicate known absent conditions (e.g. NKA) or the nonavailability of information;  or to provide pre-coordinated codes describing the propensity to specific substances (e.g. allergy to nuts).  The choice reflects these options. Elements to choose from: hl7:value[1] hl7:value[2] hl7:value CD.IPS (preferred) 0 … 1 (IPS...nce) where [1]   hl7ips-data​element-185  Diagnosis  CEN/TC 251 prEN 17269   CONF The value of @code comes preferably from value set 2.16.840.1.113883.11.22.10 IPS Allergy or Intolerance Conditions (DYNAMIC) hl7:value CD.IPS (required) 0 … 1 C When the value is used to describe the absence of information the participant used for indicating the allergy agent shall be omitted. (IPS...nce) where [2]   hl7ips-data​element-182  Allergies/Intolerances Content Status  CEN/TC 251 prEN 17269   CONF 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. (IPS...nce)   hl7ips-data​element-173  Agent  CEN/TC 251 prEN 17269 @typeCode cs 1 … 1 F CSM   Constraint IF the observation/value element is present and valued with a code derived form the  2.16.840.1.113883.11.22.9 Absent or Unknown Allergies value set THEN the  observation/participant element used to describe the agent SHALL be omitted. hl7:participantRole 1 … 1 R (IPS...nce) @classCode cs 1 … 1 F MANU hl7:playingEntity 1 … 1 R (IPS...nce) @classCode cs 1 … 1 F MMAT hl7:code CD.IPS (preferred) 1 … 1 R Code for the substance causing the allergy or intolerance. (IPS...nce)   hl7ips-data​element-196  Agent code  CEN/TC 251 prEN 17269   CONF The value of @code comes preferably from value set 2.16.840.1.113883.11.22.11 Adverse Reaction Agents (DYNAMIC) 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) (IPS...nce) where [hl7:observation [hl7:code [concat(@code, @codeSystem) = doc('include/voc-2.16.840.1.113883.11.22.16-2017-04-07T000000.xml')//valueSet [1]/conceptList/concept/concat(@code, @codeSystem) or @nullFlavor]]]   hl7ips-data​element-192  Reaction  CEN/TC 251 prEN 17269 @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) (IPS...nce) where [hl7:observation [hl7:code [(@code = '82606-5' and @codeSystem = '2.16.840.1.113883.6.1')]]]   hl7ips-data​element-189  Criticality  CEN/TC 251 prEN 17269 @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 2.16.840.1.113883.10.22.10 IPS Allergy Certainty Observation (DYNAMIC) (IPS...nce) where [hl7:observation [hl7:code [(@code = '66455-7' and @codeSystem = '2.16.840.1.113883.6.1')]]]   hl7ips-data​element-190  Certainty  CEN/TC 251 prEN 17269 @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) (IPS...nce) where [hl7:observation [hl7:code [(@code = '33999-4' and @codeSystem = '2.16.840.1.113883.6.1') or @nullFlavor]]]   hl7ips-data​element-186  Clinical Status  CEN/TC 251 prEN 17269 @typeCode cs 1 … 1 F REFR @inversionInd cs 1 … 1 F false