1.3.6.1.4.1.19376.1.5.3.1.4.6

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Trial.gif Allergies and Intolerances 1.3.6.1.4.1.19376.1.5.3.1.4.6

Allergies and intolerances are special kinds of problems, and so are also recorded in the CDA <observation> element, with classCode='OBS'. They follow the same pattern as the problem entry, with exceptions noted below.

Standards
CCD ASTM/HL7 Continuity of Care Document
CareStruct HL7 Care Provision Care Structures (DSTU)
ClinStat HL7 Clinical Statement Pattern (Draft)
Uses

See Templates using Allergies and Intolerances

Specification
Allergies and Intolerances Example

<observation classCode='OBS' moodCode='EVN' negationInd='false'>
 <templateId root='2.16.840.1.113883.10.20.1.18'/>
 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.6'/>
 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.5'/>
 <id root=' ' extension=' '/>
 <code 
   code='ALG|OINT|DALG|EALG|FALG|DINT|EINT|FINT|DNAINT|ENAINT|FNAINT' 
   codeSystem='2.16.840.1.113883.5.4' 
   codeSystemName='ObservationIntoleranceType'/>
 <text><reference value=' '/></text>
 <statusCode code='completed'/>
 <effectiveTime>
   <low value=' '/>
   <high value=' '/>
 </effectiveTime>
 <value xsi:type='CD' code=' ' codeSystem=' ' displayName=' ' codeSystemName=' '/>
 <participant typeCode='CSM'>
   <participantRole classCode='MANU'>
     <playingEntity classCode='MMAT'>
       <code  code=' ' codeSystem=' '>
         <originalText><reference value='#substance'/></originalText>
       </code>
       <name></name>
     </playingEntity>
   </participantRole>
 </participant>
 <!-- zero to many <entryRelationship> elements containing reactions -->
 <!-- zero or one <entryRelationship> elements containing severity -->
 <!-- zero or one <entryRelationship> elements containing clinical status -->
 <!-- zero to many <entryRelationship> elements containing comments -->
</observation>


<templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.5'/>
<templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.6'/>

This entry has a template identifier of 1.3.6.1.4.1.19376.1.5.3.1.4.6, and is a subtype of the Problem Entry, and so must also conform to the rules of the problem entry, which has the template identifier of 1.3.6.1.4.1.19376.1.5.3.1.4.5. These elements are required and shall be recorded exactly as shown above.

<code code='ALG|OINT|DINT|EINT|FINT|DALG|EALG|FALG|DNAINT|ENAINT|FNAINT' displayName=' ' codeSystem='2.16.840.1.113883.5.4' codeSystemName='ObservationIntoleranceType'/>

The <code> element represents the kind of allergy observation made, to a drug, food or environmental agent, and whether it is an allergy, non-allergy intolerance, or unknown class of intolerance (not known to be allergy or intolerance). The <code> element of an allergy entry shall be provided, and a code and codeSystem attribute shall be present. The example above uses the HL7 ObservationIntoleranceType vocabulary domain, which does provide suitable observation codes. Other vocabularies may be used, such as SNOMED-CT or MEDCIN. The displayName and codeSystemName attributes should be present.

<value xsi:type='CD' code=' ' codeSystem=' ' codeSystemName=' ' displayName=' '>

The <value> is a description of the allergy or adverse reaction. While the value may be a coded or an uncoded string, the type is always a coded value (xsi:type='CD'). If coded, the code and codeSystem attributes must be present. The codingSystem should reference a controlled vocabulary describing allergies and adverse reactions, see Table 5.4 12Table 5.4 12 above . If uncoded, all attributes other than xsi:type='CD' must be absent. The allergy or intolerance may not be known, in which case that fact shall be recorded appropriately. This might occur in the case where a patient experiences an allergic reaction to an unknown substance.

<participant typeCode='CSM'>
 <participantRole classCode='MANU'>
  <playingEntity classCode='MMAT'>

The substance that causes the allergy or intolerance may be specified in the <participant> element.

<code code=' ' codeSystem=' '>
 <originalText><reference value=' '/></originalText>
  </code>

The <code> element shall be present. It may contain a code and codeSystem attribute to indicate the code for the substance causing the allergy or intolerance. It shall contain a <reference> to the <originalText> in the narrative where the substance is named.

<!-- zero to many <entryRelationship> elements containing reactions -->

An allergy entry can record the reactions that are manifestations of the allergy or intolerance as shown below.

Adverse Reaction Example
<entryRelationship typeCode='MFST'>
  <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.6.1'/>
  <!-- a problem entry  -->
  <observation classCode='OBS' moodCode='EVN'>
    <templateId root='2.16.840.1.113883.10.20.1.54'/>
    <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.5'/>
      ∶
  </observation>
</entryRelationship>
<entryRelationship typeCode='MFST'>

This is a related entry (<entryRelationship>) that indicates the manifestations (typeCode='MFST') the reported allergy or intolerance. These are events that may occur, or have occurred in the past as a reaction to the allergy or intolerance.

<observation classCode='OBS' moodCode='EVN'>
 <templateId root='2.16.840.1.113883.10.20.1.54'/>
 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.5'/>
  ∶
 </observation>

The entry contained with this entry relationship is some sort of problem that is a manifestation of the allergy. It is recorded using the Problem Entry structure, with the additional template identifier (2.16.840.1.113883.10.20.1.54) indicating that this problem is a reaction.

<!-- zero or one <entryRelationship typeCode='SUBJ' inversionInd='true'> elements containing severity -->

An optional <entryRelationship> element may be present indicating the severity of the problem. When present, this <entryRelationship> element shall contain a severity observation conforming to the Severity entry template (1.3.6.1.4.1.19376.1.5.3.1.4.1). For CDA this SHALL be represented with the <entryRelationship> element. For HL7 Version 3 Messages, this SHALL be represented as a <sourceOf> element. The typeCode SHALL be ‘SUBJ’ and inversionInd SHALL be ‘true’.

<!-- zero or one <entryRelationship typeCode='REFR' inversionInd='false'> elements containing clinical status -->

An optional <entryRelationship> may be present indicating the clinical status of the allergy, e.g., resolved, in remission, active. When present, this <entryRelationship> element shall contain a clinical status observation conforming to the Problem Status Observation template (1.3.6.1.4.1.19376.1.5.3.1.4.1.1). The typeCode SHALL be ‘REFR’ and inversionInd SHALL be ‘false’. For CDA this SHALL be represented with the <entryRelationship> element. For HL7 Version 3 Messages, this SHALL be represented as a <sourceOf> element.

<!-- zero to many <entryRelationship typeCode='SUBJ' inversionInd='true'> element containing comments -->

One or more optional <entryRelationship> elements may be present providing an additional comments (annotations) for the allergy. When present, this <entryRelationship> element shall contain an entry conforming to the Comment entry template (1.3.6.1.4.1.19376.1.5.3.1.4.2). The typeCode SHALL be ‘SUBJ’ and inversionInd SHALL be ‘true’.

For CDA this SHALL be represented with the <entryRelationship> element. For HL7 Version 3 Messages, this SHALL be represented as a <sourceOf> element.