Generated Narrative: StructureDefinition ISiKAllergieUnvertraeglichkeit Name Flags Card. Type Description & Constraints AllergyIntolerance 0..* AllergyIntolerance Allergy or Intolerance (generally: Risk of adverse reaction to a substance) #xD; id S 0..1 id serverseitige, interne ID des Datensatzes #xD; meta #xD; versionId 0..1 id Eindeutiger Name der serverseitigen Version des Datensatzes #xD; lastUpdated 0..1 instant Zeitpunkt der letzten Änderung #xD; clinicalStatus S 0..1 CodeableConcept klinischer Status #xD; coding S 1..1 Coding Code defined by a terminology system #xD; system S 1..1 uri Identity of the terminology system #xD; code S 1..1 code Symbol in syntax defined by the system #xD; verificationStatus S 0..1 CodeableConcept Verifikationsstatus #xD; coding S 1..1 Coding Code defined by a terminology system #xD; system S 1..1 uri Identity of the terminology system #xD; code S 1..1 code Symbol in syntax defined by the system #xD; type S 0..1 code Type (Allergie oder Unverträglichkeit) #xD; category S 0..* code Kategorie #xD; criticality S 0..1 code Kritikalität #xD; code S 1..1 CodeableConcept Benennung der Allergie/Unverträglichkeit #xD; Slices for coding S 1..* Coding Code defined by a terminology system Slice: Unordered, Open by pattern:system #xD; coding:snomed-ct S 1..1 ISiKSnomedCTCoding Code defined by a terminology system #xD; coding:ask S 0..1 CodingASK Code defined by a terminology system #xD; system S 1..1 uri Canonische CodeSystem URL für ASK #xD; code S 1..1 code Der ASK-Code #xD; display S 0..1 string Representation defined by the system #xD; coding:atc S 0..1 CodingATC Code defined by a terminology system #xD; system S 1..1 uri Canonische CodeSystem URL für ATC #xD; version S 1..1 string Die Jahresversion von ATC. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017") #xD; code S 1..1 code Der ATC-Code #xD; display S 0..1 string Representation defined by the system #xD; text S 0..1 string Plain text representation of the concept #xD; patient S 1..1 Reference(Patient) Patientenbezug #xD; reference S 1..1 string Patienten-Link #xD; encounter S 0..1 Reference(Encounter) Aufenthaltsbezug #xD; reference S 1..1 string Encounter-Link #xD; Slices for onset[x] S 0..1 dateTime, Age, Period, Range, string Beginn-Zeitpunkt Slice: Unordered, Open by type:$this #xD; onset[x]:onsetDateTime S 0..1 dateTime Beginn der Allergie/Unvertraeglichkeit #xD; onset[x]:onsetAge S 0..1 Age Alter beim Beginn der Allergie/Unvertraeglichkeit #xD; onset[x]:onsetString S 0..1 string Freitextinformation zum Beginn der Allergie/Unvertraeglichkeit #xD; recordedDate S 0..1 dateTime Datum an dem die Allergie/Unverträglichkeit aufgezeichnet wurde #xD; recorder S 0..1 Reference(Practitioner | PractitionerRole | Patient | RelatedPerson) Person/Rolle, die die Information dokumentiert #xD; reference S 0..1 string Literal reference, Relative, internal or absolute URL #xD; display S 0..1 string Text alternative for the resource #xD; asserter S 0..1 Reference(Patient | RelatedPerson | Practitioner | PractitionerRole) Person/Rolle, die die Allergie/Unverträglichkeit festgestellt hat #xD; reference S 0..1 string Literal reference, Relative, internal or absolute URL #xD; display S 0..1 string Text alternative for the resource #xD; note S 0..* Annotation Anmerkung #xD; author[x] S 0..1 Reference(Practitioner | Patient | RelatedPerson | Organization) Individual responsible for the annotation #xD; reference S 0..1 string Literal reference, Relative, internal or absolute URL #xD; display S 0..1 string Text alternative for the resource #xD; time S 0..1 dateTime When the annotation was made #xD; text S 1..1 markdown The annotation - text content (as markdown) #xD; reaction S 0..* BackboneElement Unerwünschte Reaktion #xD; manifestation S 1..* CodeableConcept Manifestation der Reaktion #xD; Slices for coding S 0..* Coding Code defined by a terminology system Slice: Unordered, Open by pattern:system #xD; coding:snomed-ct S 0..1 ISiKSnomedCTCoding Code defined by a terminology system #xD; text S 0..1 string Plain text representation of the concept #xD; severity S 0..1 code Schweregrad der Reaktion #xD; exposureRoute S 0..1 CodeableConcept Expositionsweg #xD; Slices for coding S 0..* Coding Code defined by a terminology system Slice: Unordered, Open by pattern:system #xD; coding:snomed-ct S 0..1 ISiKSnomedCTCoding Code defined by a terminology system #xD; text S 0..1 string Plain text representation of the concept #xD; Documentation for this format
Diese Profil ermöglicht die Dokumentation von Allergien und Unverträglichkeiten in ISiK Szenarien. ### Motivation Die Möglichkeit, auf eine Übersicht der Allergien und Unverträglichkeiten eines Patienten zuzugreifen, ist eine wichtige Funktion im klinischen Behandlungsablauf. Dies gilt insbesondere, aber nicht ausschließlich, im Bereich der Arzneimitteltherapiesicherheit. Motivierender Use-Case zur Einführung dieser Profile ist die [Arzneitmitteltherapiesicherheit im Krankenhaus - AMTS](https://simplifier.net/guide/isik-medikation-v4/ImplementationGuide-markdown-UebergreifendeUseCases-AMTS). In FHIR werden Allergien und Unverträglichkeiten mit der [AllergyIntolerance](https://hl7.org/fhir/R4/allergyintolerance.html)-Ressource repräsentiert. ### Kompatibilität Für das Profil ISiKAllergieUnvertraeglichkeit wird eine Kompatibilität mit folgenden Profilen angestrebt; allerdings kann nicht sichergestellt werden, dass Instanzen, die gegen ISiKAllergieUnvertraeglichkeit valide sind, auch valide sind gegen: * [das Profil KBV_PR_Base_AllergyIntolerance der KBV](https://fhir.kbv.de/StructureDefinition/KBV_PR_Base_AllergyIntolerance) * [das Profil EMDAF_PR_AllergyIntolerance der GEVKO](https://fhir.gevko.de/StructureDefinition/EMDAF_PR_AllergyIntolerance) * [das Profil AllergyIntolerance-uv-ips der International Patient Summary](http://hl7.org/fhir/uv/ips/StructureDefinition/AllergyIntolerance-uv-ips) Hinweise zu Inkompatibilitäten können über die [Portalseite](https://service.gematik.de/servicedesk/customer/portal/16) gemeldet werden.
Allergy or Intolerance (generally: Risk of adverse reaction to a substance)
Risk of harmful or undesirable, physiological response which is unique to an individual and associated with exposure to a substance.
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.
AllergyIntolerance.clinicalStatus SHALL be present if verificationStatus is not entered-in-error.
verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').exists() or clinicalStatus.exists()
f:verificationStatus/f:coding/f:code/@value='entered-in-error' or exists(f:clinicalStatus)
AllergyIntolerance.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
verificationStatus.coding.where(system = 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' and code = 'entered-in-error').empty() or clinicalStatus.empty()
not(f:verificationStatus/f:coding/f:code/@value='entered-in-error') or not(exists(f:clinicalStatus))
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Observation[classCode=OBS, moodCode=EVN]
serverseitige, interne ID des Datensatzes
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
**bedingtes Pflichtfeld/bedingtes MS:** Alle von einem Server bereitgestellten Ressourcen MÜSSEN über eine `id` verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine `id`verfügen.
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Eindeutiger Name der serverseitigen Version des Datensatzes
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
Alle von einem Server bereitgestellten Ressourcen SOLLEN über eine `versionID` verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über eine `versionID`verfügen.
When the resource last changed - e.g. when the version changed.
Alle von einem Server bereitgestellten Ressourcen SOLLEN über ein `lastUpdate` verfügen. Von Clients erzeugte Ressourcen, die im Kontext einer CREATE-Interaktion übermittelt werden, MÜSSEN NICHT über ein `lastUpdate`verfügen.
Identifies where the resource comes from
A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Profiles this resource claims to conform to
A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Security Labels applied to this resource
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Security Labels from the Healthcare Privacy and Security Classification System.
Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
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).
Text summary of the resource, for human interpretation
A human-readable narrative that contains a summary of the resource and can 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 "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
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.
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Business identifiers assigned to this AllergyIntolerance by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Allows identification of the AllergyIntolerance as it is known by various participating systems and in a way that remains consistent across servers.
The clinical status of the allergy or intolerance.
**Begründung MS:** Der klinische Status ist notwendig, um aktive gegenüber zurückliegenden Allergien unterscheiden und in Medikations- sowie Entscheidungsunterstützungsprozessen korrekt berücksichtigen zu können.
This element is labeled as a modifier because the status contains the codes inactive and resolved that mark the AllergyIntolerance as no longer active.
Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
A reference to a code defined by a terminology system.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The identification of the code system that defines the meaning of the symbol in the code.
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
A representation of the meaning of the code in the system, following the rules of the system.
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).
**Begründung MS:** Der Verifizierungsstatus macht transparent, ob eine Meldung bestätigt, widerlegt oder noch im Verdacht ist und ist Voraussetzung für belastbare AMTS-Prüfungen.
This element is labeled as a modifier because the status contains the codes refuted and entered-in-error that mark the AllergyIntolerance as not currently valid.
Assertion about certainty associated with a propensity, or potential risk, of a reaction to the identified substance.
Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
Identification of the underlying physiological mechanism for the reaction risk.
**Begründung MS:** Gibt die Unterscheidung zwischen Allergie und Unverträglichkeit an.
Identification of the underlying physiological mechanism for a Reaction Risk.
**Begründung MS:** Die Kategorie erlaubt das Filtern, z. B. nach Arzneimittel-, Lebensmittel- oder Umweltallergien, und unterstützt zielgerichtete Warn- und Recherchefunktionen.
Category of an identified substance associated with allergies or intolerances.
Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance.
**Begründung MS:** Die Kritikalität beschreibt das erwartete Risiko bei erneuter Exposition und dient der Priorisierung von Warnhinweisen.
Estimate of the potential clinical harm, or seriousness, of a reaction to an identified substance.
inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=SEV, value <= SeverityObservation (Severity Level)]
Benennung der Allergie/Unverträglichkeit
Code for an allergy or intolerance statement (either a positive or a negated/excluded statement). This may be a code for a substance or pharmaceutical product that is considered to be responsible for the adverse reaction risk (e.g., "Latex"), an allergy or intolerance condition (e.g., "Latex allergy"), or a negated/excluded code for a specific substance or class (e.g., "No latex allergy") or a general or categorical negated statement (e.g., "No known allergy", "No known drug allergies"). Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk, but it must be consistent with it. For instance, it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'. If a receiving system is unable to confirm that AllergyIntolerance.reaction.substance falls within the semantic scope of AllergyIntolerance.code, then the receiving system should ignore AllergyIntolerance.reaction.substance.
**Begründung Pflichtfeld:** Nur mit einer codierten oder textuell benannten Auslösersubstanz lässt sich die Allergie klinisch interpretieren und für Interaktionsprüfungen nutzen.
Type of the substance/product, allergy or intolerance condition, or negation/exclusion codes for reporting no known allergies.
substance/product: .participation[typeCode=CAGNT].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType] negated/excluded substance/product: .participation[typeCode=CAGNT, negationInd=true].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType] positive or negated/excluded condition/situation: Observation.code=ASSERTION; Observation.value
Die Jahresversion von ATC. Angegeben wird immer die vierstellige Jahreszahl (z.B. "2017")
Bie Verwendung von ATC ist die Angabe der Version zwingend erforderlich. Hierdurch wird der Tatsache Rechnung getragen, dass jede der jährlich neu erscheinenden Fassung von ATC ein neues Codesystem darstellt.
The patient who has the allergy or intolerance.
**Begründung Must-Support:** Ein Patientenbezug der AllergieUnverträglichkeit MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
**Begründung MS:** Die Verlinkung auf eine Patienten-Ressource dient der technischen Zuordnung der Dokumentation zu einem Patienten und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. Im ISik Kontext MUSS die referenzierte Ressource konform zu [ISiKPatient](https://gematik.de/fhir/isik/StructureDefinition/ISiKPatient) sein. Jenseits von ISiK KÖNNEN weitere Instanzen mit anderen Profilen referenziert werden.
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).
Plain text narrative that identifies the resource in addition to the resource reference.
This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.
The encounter when the allergy or intolerance was asserted.
**Begründung Must-Support:** Ein Aufenthaltsbezug der AllergieUnverträglichkeit MUSS stets zum Zwecke der Nachvollziehbarkeit und Datenintegrität vorliegen.
.inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
**Begründung MS:** Die Verlinkung auf eine Encounter-Ressource dient der technischen Zuordnung der Dokumentation zu einem Aufenthalt und ermöglicht wichtige API-Funktionen wie verkettete Suche, (Reverse-)Include etc. Im ISik Kontext MUSS die referenzierte Ressource konform zu [ISiKKontaktGesundheitseinrichtung](https://gematik.de/fhir/isik/StructureDefinition/ISiKKontaktGesundheitseinrichtung) sein. Jenseits von ISiK KÖNNEN weitere Instanzen mit anderen Profilen referenziert werden.
Estimated or actual date, date-time, or age when allergy or intolerance was identified.
**Begründung MS:** Der dokumentierte Beginn unterstützt die medizinische Bewertung, ob eine Allergie aktuell relevant ist, und wird in CapabilityStatements als Suchparameter gefordert.
**Begründung MS:** Diese Variante erlaubt es, den Beginn als exakten Zeitstempel zu übertragen, wie er in Primärsystemen üblich ist.
Alter beim Beginn der Allergie/Unvertraeglichkeit
**Begründung MS:** Für lang zurückliegende Ereignisse wird der Beginn häufig nur als Alter dokumentiert
Freitextinformation zum Beginn der Allergie/Unvertraeglichkeit
**Begründung MS:** Steht keine strukturierte Angabe zur Verfügung, verhindert eine Freitextbeschreibung des Beginns Informationsverlust.
Datum an dem die Allergie/Unverträglichkeit aufgezeichnet wurde
The recordedDate represents when this particular AllergyIntolerance record was created in the system, which is often a system-generated date.
**Begründung MS:** Der Dokumentationszeitpunkt ist wichtig für Verlauf, Audits und Suchfunktionen nach frisch erfassten Allergien.
Person/Rolle, die die Information dokumentiert
Individual who recorded the record and takes responsibility for its content.
**Begründung MS:** Die dokumentierende Person ermöglicht fachliche Rückfragen und unterstützt nachvollziehbare Verantwortungsketten.
Literal reference, Relative, internal or absolute URL
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
Person/Rolle, die die Allergie/Unverträglichkeit festgestellt hat
The source of the information about the allergy that is recorded.
**Begründung MS:** Die feststellende Person oder Rolle macht die klinische Verantwortlichkeit transparent.
IAM-14 (if patient) / IAM-18 (if practitioner)
Date(/time) of last known occurrence of a reaction
Represents the date and/or time of the last known occurrence of a reaction event.
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.
outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)].effectiveTime
Additional narrative about the propensity for the Adverse Reaction, not captured in other fields.
**Begründung MS:** Anmerkungen transportieren kontextuelle Details (z. B. individuelle Auslöser oder Maßnahmen), die in Codes nicht erfasst werden können.
Individual responsible for the annotation
The individual responsible for making the annotation.
Organization is used when there's no need for specific attribution as to who made the comment.
Indicates when this particular annotation was made.
The annotation - text content (as markdown)
The text of the annotation in markdown format.
Details about each adverse reaction event linked to exposure to the identified substance.
**Begründung MS:** Die beobachtete Reaktion ist für die klinische Bewertung der Gefährdung essenziell und Grundlage für Entscheidungshilfen.
outBoundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN, code <= CommonClinicalObservationType, value <= ObservationValue (Reaction Type)]
Extensions that cannot be ignored even if unrecognized
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 in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Specific substance or pharmaceutical product considered to be responsible for event
Identification of the specific substance (or pharmaceutical product) considered to be responsible for the Adverse Reaction event. Note: the substance for a specific reaction may be different from the substance identified as the cause of the risk, but it must be consistent with it. For instance, it may be a more specific substance (e.g. a brand medication) or a composite product that includes the identified substance. It must be clinically safe to only process the 'code' and ignore the 'reaction.substance'. If a receiving system is unable to confirm that AllergyIntolerance.reaction.substance falls within the semantic scope of AllergyIntolerance.code, then the receiving system should ignore AllergyIntolerance.reaction.substance.
Coding of the specific substance (or pharmaceutical product) with a terminology capable of triggering decision support should be used wherever possible. The 'code' element allows for the use of a specific substance or pharmaceutical product, or a group or class of substances. In the case of an allergy or intolerance to a class of substances, (for example, "penicillins"), the 'reaction.substance' element could be used to code the specific substance that was identified as having caused the reaction (for example, "amoxycillin"). Duplication of the value in the 'code' and 'reaction.substance' elements is acceptable when a specific substance has been recorded in 'code'.
Codes defining the type of the substance (including pharmaceutical products).
outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].participation[typeCode=CSM].role[classCode=ADMM].player[classCode=MAT, determinerCode=KIND, code <= ExposureAgentEntityType]
Clinical symptoms and/or signs that are observed or associated with the adverse reaction event.
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.
Clinical symptoms and/or signs that are observed or associated with an Adverse Reaction Event.
Text description about the reaction as a whole, including details of the manifestation if required.
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.
Record of the date and/or time of the onset of the Reaction.
Clinical assessment of the severity of the reaction event as a whole, potentially considering multiple different manifestations.
It is acknowledged that this assessment is very subjective. There may be some specific practice domains where objective scales have been applied. Objective scales can be included in this model as extensions.
Clinical assessment of the severity of a reaction event as a whole, potentially considering multiple different manifestations.
Identification of the route by which the subject was exposed to the substance.
Coding of the route of exposure with a terminology should be used wherever possible.
A coded concept describing the route or physiological path of administration of a therapeutic agent into or onto the body of a subject.
outBoundRelationship[typeCode=SAS].target[classCode=SBADM, code <= ExposureCode].routeCode
Text about event not captured in other fields
Additional text about the adverse reaction event not captured in other fields.
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.