AllergyIntolerance

Overview

The AllergyIntolerance resource provides the clinical assessment of a patient’s allergy or intolerance when exposed to a specific substance or class of substance including information about the adverse reaction. Substances include, but are not limited to, medications, foods, environment (such as plants and animals), and insect bites. The Allergy/Intolerance list exists as a patient safety tool for clinical decision support when ordering medications and nutrition or guiding clinical treatments. This resource does NOT include adverse reactions or adverse events which are expected for the circumstance such as an over-dose or drug-drug interaction or an error/failure in the clinical process. References to implicitRules and modifierExtensions are NOT supported and will fail a Create or Update request.

No Known Allergies (NKA) or No Known Medication Allergies (NKMA) will be conveyed with predefined codes while Not Asked is conveyed via the absence of information (empty query response). Consumers can supply the negation codes (No known allergy (situation))(716186003) or No Known Medication Allergies (409137002) as long as there are no other active allergies on the patient’s profile. If there are other active allergies on the patient’s profile and the consumer tries to add one of the codes above, the service will throw an exception.

If NKA and/or NKMA exist on the patient’s allergy profile and a new allergy is added, the NKA and NKMA will be canceled.

If the consumer is sending in what is deemed to be a duplicate (codified or free text), the service will update the existing allergy or reaction rather than adding a duplicate allergy or reaction.

Assuming a patient safety or decision support use case, a consumer should avoid querying by status since it is not a required field and can ignore any entered-in-error allergies or intolerances.

The following fields are returned if valued:

Terminology Bindings

AllergyIntolerance.clinicalStatus
AllergyIntolerance.verificationStatus
  • Description
    • Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance (including pharmaceutical product).
  • Details: AllergyIntolerance Verification Status Codes
    System: http://terminology.hl7.org/CodeSystem/allergyintolerance-verification

AllergyIntolerance.type
  • Description
    • Identification of the underlying physiological mechanism for the reaction risk.
  • Details: AllergyIntoleranceType
    System: http://hl7.org/fhir/allergy-intolerance-type

AllergyIntolerance.category
  • Description
    • Category of the identified substance.
  • Details: AllergyIntoleranceCategory
    System: http://hl7.org/fhir/allergy-intolerance-category

AllergyIntolerance.criticality
  • Description
    • Estimate of the potential clinical harm, or seriousness, of the reaction to the identified substance.
  • Details: AllergyIntoleranceCriticality
    System: http://hl7.org/fhir/allergy-intolerance-criticality

AllergyIntolerance.code
  • Description
    • 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").
  • Details: RxNorm
    System: http://www.nlm.nih.gov/research/umls/rxnorm

  • Details: Substance Code
    System: http://hl7.org/fhir/ValueSet/substance-code

  • Details: SNOMED CT
    System: http://snomed.info/sct

AllergyIntolerance.reaction.manifestation
  • Description
    • Clinical symptoms and/or signs that are observed or associated with the adverse reaction event.
  • Details: SNOMED CT Clinical Findings
    System: http://snomed.info/sct

AllergyIntolerance.reaction.severity
  • Description
    • Clinical assessment of the severity of a reaction event as a whole.
  • Details: AllergyIntoleranceSeverity
    System: http://hl7.org/fhir/reaction-event-severity

Search for AllergyIntolerances that meet supplied query parameters:

GET /AllergyIntolerance?:parameters

Authorization Types

Parameters

Name Required? Type Description
_id This or patient, if populated all other parameters are not allowed token The logical resource id associated with the resource. Example: 12345
patient This or _id reference Who the sensitivity is for. Example: 12345
clinical-status No token The clinical status of the allergy or intolerance. Example: active, inactive, resolved
_revinclude No token Provenance resource entries to be returned as part of the bundle. Example:_revinclude=Provenance:target

Notes:

The _revinclude parameter may be provided once with the value Provenance:target. Example: _revinclude=Provenance:target

The _revinclude parameter may be provided with the _id/patient parameter. Example: _id=74771957,S-75479691&_revinclude=Provenance:target

When _revinclude is provided in a request to the closed endpoint, the OAuth2 token must include the user/Provenance.read scope. Currently patient/Provenance.read is not supported and hence _revinclude cannot be utilised for patient persona.

Headers

Accept: application/fhir+json
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance?patient=12742399

Response

Status: 200 OK
{
  "resourceType": "Bundle",
  "id": "30e959ca-24f5-43a5-bf8d-46bbb1991b01",
  "type": "searchset",
  "link": [
    {
      "relation": "self",
      "url": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance?patient=12742399"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/12760025",
      "resource": {
        "resourceType": "AllergyIntolerance",
        "id": "12760025",
        "meta": {
          "versionId": "12760025",
          "lastUpdated": "2020-03-04T20:16:02Z"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Allergy Intolerance</b></p><p><b>Patient</b>: SMART, SANDY A</p><p><b>Allergy</b>: Eggs (edible) (substance)</p><p><b>Verification Status</b>: Confirmed</p><p><b>Clinical Status</b>: Active</p><p><b>Criticality</b>: High Risk</p><p><b>Category</b>: Food</p><p><b>Reactions</b>: Breathing abnormal</p><p><b>Onset</b>: Dec 14, 2019  6:00 P.M. CST</p></div>"
        },
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
              "code": "active",
              "display": "Active"
            }
          ],
          "text": "Active"
        },
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
              "code": "confirmed",
              "display": "Confirmed"
            }
          ],
          "text": "Active"
        },
        "type": "allergy",
        "category": [
          "food"
        ],
        "criticality": "high",
        "code": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "102263004",
              "display": "Eggs (edible) (substance)"
            }
          ],
          "text": "Egg"
        },
        "patient": {
          "reference": "Patient/12742399",
          "display": "SMART, SANDY A"
        },
        "encounter": {
          "reference": "Encounter/97953523"
        },
        "onsetDateTime": "2019-12-15T00:00:00Z",
        "recordedDate": "2020-03-04T20:16:02Z",
        "recorder": {
          "reference": "Practitioner/12724045",
          "display": "Graham, Joshua"
        },
        "reaction": [
          {
            "id": "12760027",
            "manifestation": [
              {
                "coding": [
                  {
                    "system": "http://snomed.info/sct",
                    "code": "386813002",
                    "display": "Abnormal breathing (finding)"
                  }
                ],
                "text": "Breathing abnormal"
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/12760007",
      "resource": {
        "resourceType": "AllergyIntolerance",
        "id": "12760007",
        "meta": {
          "versionId": "12760007",
          "lastUpdated": "2020-03-04T20:13:51Z"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Allergy Intolerance</b></p><p><b>Patient</b>: SMART, SANDY A</p><p><b>Allergy</b>: Cow&#39;s milk (substance)</p><p><b>Verification Status</b>: Confirmed</p><p><b>Clinical Status</b>: Active</p><p><b>Criticality</b>: High Risk</p><p><b>Category</b>: Food</p><p><b>Reactions</b>: Hives</p><p><b>Onset</b>: Dec 14, 2019  6:00 P.M. CST</p></div>"
        },
        "contained": [
          {
            "resourceType": "RelatedPerson",
            "id": "638993",
            "patient": {
              "reference": "Patient/12742399",
              "display": "SMART, SANDY A"
            },
            "relationship": [
              {
                "coding": [
                  {
                    "system": "http://snomed.info/sct",
                    "code": "35359004",
                    "display": "Family (social concept)"
                  },
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                    "code": "FAMMEMB",
                    "display": "family member"
                  }
                ],
                "text": "family member"
              }
            ]
          }
        ],
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
              "code": "active",
              "display": "Active"
            }
          ],
          "text": "Active"
        },
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
              "code": "confirmed",
              "display": "Confirmed"
            }
          ],
          "text": "Active"
        },
        "type": "allergy",
        "category": [
          "food"
        ],
        "criticality": "high",
        "code": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "3718001",
              "display": "Cow's milk (substance)"
            }
          ],
          "text": "Cow's Milk"
        },
        "patient": {
          "reference": "Patient/12742399",
          "display": "SMART, SANDY A"
        },
        "encounter": {
          "reference": "Encounter/97953523"
        },
        "onsetDateTime": "2019-12-15T00:00:00Z",
        "recordedDate": "2020-03-04T20:13:51Z",
        "recorder": {
          "reference": "Practitioner/12724045",
          "display": "Graham, Joshua"
        },
        "asserter": {
          "reference": "#638993"
        },
        "reaction": [
          {
            "id": "12760009",
            "manifestation": [
              {
                "coding": [
                  {
                    "system": "http://snomed.info/sct",
                    "code": "247472004",
                    "display": "Weal (disorder)"
                  }
                ],
                "text": "Hives"
              }
            ]
          }
        ]
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Example with RevInclude

Authorization Types

Request

GET https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance?_id=74771957,S-75479691&_revinclude=Provenance:target #### Response
Status: 200 OK
{
  "resourceType": "Bundle",
  "id": "65ee4c79-3514-4eab-b606-10ad56fb0d5d",
  "type": "searchset",
  "link": [
    {
      "relation": "self",
      "url": "https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance?_id=74771957%2CS-75479691&_revinclude=Provenance%3Atarget"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/74771957",
      "resource": {
        "resourceType": "AllergyIntolerance",
        "id": "74771957",
        "meta": {
          "versionId": "74771957",
          "lastUpdated": "2019-05-15T13:15:25Z"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns='http://www.w3.org/1999/xhtml'><p><b>Allergy Intolerance</b></p>\n              <p><b>Patient</b>: John, Smith</p><p><b>Allergy</b>: Peanut - dietary (substance)</p>\n              <p><b>Verification Status</b>: Confirmed</p><p><b>Clinical Status</b>: Active</p>\n              <p><b>Criticality</b>: High Risk</p><p><b>Category</b>: Medication</p>\n              <p><b>Onset</b>: May 15, 2019  1:15 P.M. UTC</p></div>"
        },
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
              "code": "active",
              "display": "Active"
            }
          ],
          "text": "Active"
        },
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
              "code": "confirmed",
              "display": "Confirmed"
            }
          ],
          "text": "Active"
        },
        "type": "allergy",
        "category": [
          "medication"
        ],
        "criticality": "high",
        "code": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "256349002",
              "display": "Peanut - dietary (substance)"
            }
          ],
          "text": "Peanuts"
        },
        "patient": {
          "reference": "Patient/150915497",
          "display": "John, Smith"
        },
        "encounter": {
          "reference": "Encounter/44324934"
        },
        "onsetDateTime": "2019-05-15T13:15:25Z",
        "recordedDate": "2019-05-15T13:15:25Z",
        "recorder": {
          "reference": "Practitioner/8176589",
          "display": "DIRECTORYSERVICEUSER, DIRECTORYSERVICEUSER"
        },
        "asserter": {
          "reference": "Patient/150915497",
          "display": "John, Smith"
        }
      },
      "search": {
        "mode": "match"
      }
    },
    {
      "fullUrl": "https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/S-75479691",
      "resource": {
        "resourceType": "AllergyIntolerance",
        "id": "S-75479691",
        "meta": {
          "versionId": "1",
          "lastUpdated": "2020-03-19T20:47:44Z",
          "security": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationValue",
              "code": "UNCERTREL",
              "display": "Uncertain Reliability"
            }
          ]
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns='http://www.w3.org/1999/xhtml'><p><b>Allergy Intolerance</b></p>\n              <p><b>Patient</b>: MARSTON, JACK</p><p><b>Meta Security</b>: Uncertain Reliability</p>\n              <p><b>Allergy</b>: Strawberry (substance)</p><p><b>Verification Status</b>: Confirmed</p>\n              <p><b>Clinical Status</b>: Active</p><p><b>Criticality</b>: High Risk</p>\n              <p><b>Category</b>: Medication</p><p><b>Onset</b>: Sep 11, 2019 12:00 A.M. CDT</p>\n              <p><b>Note</b>: Allergy reported by patient.</p></div>"
        },
        "contained": [
          {
            "resourceType": "PractitionerRole",
            "id": "638995",
            "code": [
              {
                "coding": [
                  {
                    "system": "http://snomed.info/sct",
                    "code": "106292003",
                    "display": "Professional nurse (occupation)"
                  }
                ],
                "text": "Professional nurse (occupation)"
              }
            ]
          }
        ],
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
              "code": "active",
              "display": "Active"
            }
          ],
          "text": "Active"
        },
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
              "code": "confirmed",
              "display": "Confirmed"
            }
          ],
          "text": "Active"
        },
        "type": "allergy",
        "category": [
          "medication"
        ],
        "criticality": "high",
        "code": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "102261002",
              "display": "Strawberry (substance)"
            }
          ],
          "text": "Strawberry"
        },
        "patient": {
          "reference": "Patient/166045489",
          "display": "MARSTON, JACK"
        },
        "onsetDateTime": "2019-09-11T05:00:00Z",
        "recorder": {
          "reference": "Practitioner/1",
          "display": "SYSTEM, SYSTEM"
        },
        "asserter": {
          "reference": "#638995"
        },
        "note": [
          {
            "authorReference": {
              "reference": "Practitioner/2578010"
            },
            "text": "Allergy reported by patient."
          }
        ]
      },
      "search": {
        "mode": "match"
      }
    },
    {
      "fullUrl": "https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Provenance/all-4957069",
      "resource": {
        "resourceType": "Provenance",
        "id": "all-4957069",
        "meta": {
          "versionId": "4957069",
          "lastUpdated": "2020-03-16T21:45:09Z"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns='http://www.w3.org/1999/xhtml'><p><b>Provenance</b></p>\n              <p><b>Target</b>:</p><ul><li>AllergyIntolerance/74771957</li></ul>\n              <p><b>Recorded</b>: Mar 16, 2020  4:45 P.M. CDT</p>\n              <p><b>Agents</b>:</p>\n              <dl><dt>Unknown</dt><dd><b>Agent Type</b>: Author</dd><dd><b>Agent Role</b>: Source</dd></dl>\n              <p><b>Entity Source</b>: DocumentReference/S-200</p></div>"
        },
        "target": [
          {
            "reference": "AllergyIntolerance/74771957"
          }
        ],
        "recorded": "2020-03-16T21:45:09Z",
        "agent": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
                  "code": "author"
                }
              ],
              "text": "Author"
            },
            "role": [
              {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
                    "code": "SOURCE"
                  }
                ],
                "text": "Source"
              }
            ],
            "who": {
              "reference": "Organization/40475456",
              "display": "Unknown"
            }
          }
        ],
        "entity": [
          {
            "role": "source",
            "what": {
              "reference": "DocumentReference/S-200"
            }
          }
        ]
      },
      "search": {
        "mode": "include"
      }
    },
    {
      "fullUrl": "https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/Provenance/all-16897171",
      "resource": {
        "resourceType": "Provenance",
        "id": "all-16897171",
        "meta": {
          "versionId": "16897171",
          "lastUpdated": "2021-03-26T08:03:53Z"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns='http://www.w3.org/1999/xhtml'><p><b>Provenance</b></p>\n              <p><b>Target</b>:</p><ul><li>AllergyIntolerance/S-75479691</li></ul>\n              <p><b>Recorded</b>: Mar 25, 2021  9:57 A.M. CDT</p>\n              <p><b>Agents</b>:</p>\n              <dl><dt>Baseline East Medical Center</dt><dd><b>Agent Type</b>: Author</dd>\n              <dd><b>Agent Role</b>: Source</dd></dl>\n              <p><b>Entity Source</b>: DocumentReference/S-201</p></div>"
        },
        "target": [
          {
            "reference": "AllergyIntolerance/S-75479691"
          }
        ],
        "recorded": "2021-03-25T14:57:43Z",
        "agent": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
                  "code": "author"
                }
              ],
              "text": "Author"
            },
            "role": [
              {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
                    "code": "SOURCE"
                  }
                ],
                "text": "Source"
              }
            ],
            "who": {
              "reference": "Organization/619848",
              "display": "Baseline East Medical Center"
            }
          }
        ],
        "entity": [
          {
            "role": "source",
            "what": {
              "reference": "DocumentReference/S-201"
            }
          }
        ]
      },
      "search": {
        "mode": "include"
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Patient Authorization Request

GET https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance?patient=12742399

Response

Status: 200 OK
{
  "resourceType": "Bundle",
  "id": "92a4b8d7-58dc-4b37-b387-bebeb68def51",
  "type": "searchset",
  "link": [
    {
      "relation": "self",
      "url": "http://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance?patient=12724066"
    }
  ],
  "entry": [
    {
      "fullUrl": "https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/12766993",
      "resource": {
        "resourceType": "AllergyIntolerance",
        "id": "12766993",
        "meta": {
          "versionId": "12766993",
          "lastUpdated": "2020-10-14T19:24:57Z"
        },
        "text": {
          "status": "generated",
          "div": "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Allergy Intolerance</b></p><p><b>Patient</b>: SMART, NANCY</p><p><b>Allergy</b>: Penicillium brevicompactum (organism)</p><p><b>Verification Status</b>: Confirmed</p><p><b>Clinical Status</b>: Active</p><p><b>Criticality</b>: High Risk</p><p><b>Category</b>: Medication</p></div>"
        },
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
              "code": "active",
              "display": "Active"
            }
          ],
          "text": "Active"
        },
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
              "code": "confirmed",
              "display": "Confirmed"
            }
          ],
          "text": "Active"
        },
        "type": "allergy",
        "category": [
          "medication"
        ],
        "criticality": "high",
        "code": {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "5711000146109",
              "display": "Penicillium brevicompactum (organism)"
            }
          ],
          "text": "Penicillium brevicompactum"
        },
        "patient": {
          "reference": "Patient/12724066",
          "display": "SMART, NANCY"
        },
        "encounter": {
          "reference": "Encounter/97955410"
        },
        "recordedDate": "2020-10-14T19:24:57Z"
      }
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Retrieve by id

List an individual AllergyIntolerance by its id:

GET /AllergyIntolerance/:id

Authorization Types

Headers

Accept: application/fhir+json
Authorization: <OAuth2 Bearer Token>

Example

Request

GET https://fhir-open.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/12760025

Response

Status: 200 OK
{
  "resourceType": "AllergyIntolerance",
  "id": "12760025",
  "meta": {
    "versionId": "12760025",
    "lastUpdated": "2020-03-04T20:16:02Z"
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Allergy Intolerance</b></p><p><b>Patient</b>: SMART, SANDY A</p><p><b>Allergy</b>: Eggs (edible) (substance)</p><p><b>Verification Status</b>: Confirmed</p><p><b>Clinical Status</b>: Active</p><p><b>Criticality</b>: High Risk</p><p><b>Category</b>: Food</p><p><b>Reactions</b>: Breathing abnormal</p><p><b>Onset</b>: Dec 14, 2019  6:00 P.M. CST</p></div>"
  },
  "clinicalStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
        "code": "active",
        "display": "Active"
      }
    ],
    "text": "Active"
  },
  "verificationStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
        "code": "confirmed",
        "display": "Confirmed"
      }
    ],
    "text": "Active"
  },
  "type": "allergy",
  "category": [
    "food"
  ],
  "criticality": "high",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "102263004",
        "display": "Eggs (edible) (substance)"
      }
    ],
    "text": "Egg"
  },
  "patient": {
    "reference": "Patient/12742399",
    "display": "SMART, SANDY A"
  },
  "encounter": {
    "reference": "Encounter/97953523"
  },
  "onsetDateTime": "2019-12-15T00:00:00Z",
  "recordedDate": "2020-03-04T20:16:02Z",
  "recorder": {
    "reference": "Practitioner/12724045",
    "display": "Graham, Joshua"
  },
  "reaction": [
    {
      "id": "12760027",
      "manifestation": [
        {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "386813002",
              "display": "Abnormal breathing (finding)"
            }
          ],
          "text": "Breathing abnormal"
        }
      ]
    }
  ]
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Patient Authorization Request For Confirmed Status

GET https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/12760025

Response

Status: 200 OK
{
  "resourceType": "AllergyIntolerance",
  "id": "12766993",
  "meta": {
    "versionId": "12766993",
    "lastUpdated": "2020-10-14T19:24:57Z"
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Allergy Intolerance</b></p><p><b>Patient</b>: SMART, NANCY</p><p><b>Allergy</b>: Penicillium brevicompactum (organism)</p><p><b>Verification Status</b>: Confirmed</p><p><b>Clinical Status</b>: Active</p><p><b>Criticality</b>: High Risk</p><p><b>Category</b>: Medication</p></div>"
  },
  "clinicalStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
        "code": "active",
        "display": "Active"
      }
    ],
    "text": "Active"
  },
  "verificationStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
        "code": "confirmed",
        "display": "Confirmed"
      }
    ],
    "text": "Active"
  },
  "type": "allergy",
  "category": [
    "medication"
  ],
  "criticality": "high",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "5711000146109",
        "display": "Penicillium brevicompactum (organism)"
      }
    ],
    "text": "Penicillium brevicompactum"
  },
  "patient": {
    "reference": "Patient/12724066",
    "display": "SMART, NANCY"
  },
  "encounter": {
    "reference": "Encounter/97955410"
  },
  "recordedDate": "2020-10-14T19:24:57Z"
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Patient Authorization Request For Entered in Error Status

GET https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/12760051

Response

Status: 200 OK
{
  "resourceType": "AllergyIntolerance",
  "id": "12760051",
  "meta": {
    "versionId": "12765897",
    "lastUpdated": "2020-09-21T07:48:43Z"
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Allergy Intolerance</b></p><p><b>Patient</b>: SMART, NANCY</p><p><b>Verification Status</b>: Entered in Error</p></div>"
  },
  "verificationStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
        "code": "entered-in-error",
        "display": "Entered in Error"
      }
    ],
    "text": "Canceled"
  },
  "code": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/data-absent-reason",
        "code": "error",
        "display": "Error"
      }
    ],
    "text": "Error"
  },
  "patient": {
    "reference": "Patient/12724066",
    "display": "SMART, NANCY"
  }
}

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Create

Create new allergy.

POST /AllergyIntolerance

Implementation Notes

Authorization Types

Headers

Authorization: <OAuth2 Bearer Token>
Content-Type: application/fhir+json

Body Fields

Name Required Type
resourceType Yes string
  • Description
    • The type of the FHIR resource.
  • Example
    • {
        "resourceType": "AllergyIntolerance"
      }
      
  • Notes
    • resourceType must be AllergyIntolerance.
contained No List of Resource
  • Description
    • Contained, inline Resources.
  • Example
    • Contained RelatedPerson
      {
        "contained": [
          {
            "resourceType":"RelatedPerson",
            "id":"638996",
            "relationship":[
              {
                "coding":[
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                    "code": "PRN",
                  }
                ]
              }
            ],
            "patient":{
              "reference":"Patient/12742400"
            }
          }
        ]
      }
      
  • Example
    • Contained PractitionerRole
      {
        "contained": [
          {
            "resourceType":"PractitionerRole",
            "id":"638994",
            "code":[
              {
                "coding":[
                  {
                    "system":"http://terminology.hl7.org/CodeSystem/practitioner-role",
                    "code":"doctor"
                  }
                ]
              }
            ]
          }
        ]
      }
      
  • Notes
    • These should be either PractitionerRole or RelatedPerson resources that are relative references from the asserter field.
clinicalStatus Yes CodeableConcept
  • Description
    • The clinical status of the AllergyIntolerance.
  • Example
    • {
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
              "code": "resolved"
            }
          ]
        }
      }
      
  • Notes
    • A clinicalStatus must always be provided while creating an allergy.
verificationStatus No CodeableConcept
  • Description
    • The verification status to support or decline the clinical status of allergy.
  • Example
    • {
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
              "code": "confirmed"
            }
          ]
        }
      }
      
  • Notes
    • verificationStatus codes of entered-in-error and refuted are not supported during AllergyIntolerance creates.
type No code
  • Description
    • allergy | intolerance - Underlying mechanism (if known)
  • Example
    • {
        "type": "allergy"
      }
      
category No List of code
  • Description
    • Category of the identified code.
  • Example
    • {
        "category":[
          "environment",
          "food",
          "medication"
        ]
      }
      
  • Notes
      • Category code of biologic is not supported
      • Only a single category will be written to the allergy
      • When multiple categories are provided, the category to be picked is based on precedence. medication > food > environment.
criticality No List of code
  • Description
    • low | high | unable-to-assess
  • Example
    • {
        "criticality": "high"
      }
      
code Yes CodeableConcept
  • Description
    • Code that identifies the allergy or intolerance
  • Example
    • {
        "code":{
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "9220005"
            }
          ],
          "text": "Plant phenol oil"
        }
      }
      
  • Notes
    • A code must always be provided while creating an allergy.
patient Yes Reference
  • Description
    • Indicates the patient who the sensitivity is for.
  • Example
    • {
        "patient": {
          "reference": "Patient/631923"
        }
      }
      
encounter No Reference
  • Description
    • Indicates the encounter when the allergy or intolerance was asserted.
  • Example
    • {
        "encounter": {
          "reference":"Encounter/1693915"
        }
      }
      
onset[x] No dateTime
  • Description
    • Estimated or actual date or date-time the allergy began, in the opinion of the clinician.
  • Example
    • {
        "onsetDateTime": "2015-10-14T13:13:20-06:00"
      }
      
  • Notes
      • Only a type of dateTime is supported.
      • The dateTime is converted to a GMT date.
asserter No Reference
  • Description
    • Indicates the source of information about the allergy.
  • Example
    • {
        "asserter":{
          "reference":"#638994"
        }
      }
      
  • Notes
    • Asserter must be provided and linked to the contained resource, if a contained resource is specified.
note No List of Annotation
  • Description
    • Additional narrative about the allergy not captured in other fields.
  • Example
    • {
        "note": [
          {
            "authorReference": {
              "reference": "Practitioner/2578010"
            },
            "text": "Allergy reported by patient."
          }
        ]
      }
      
  • Notes
    • An author and text can be specified but note.time will always be defaulted.
reaction No List of BackboneElement
  • Description
    • Adverse Reaction Events linked to exposure to substance
  • Example
    • {
        "reaction":[
          {
            "manifestation":[
              {
                "coding":[
                  {
                    "system":"http://snomed.info/sct",
                    "code":"414322003"
                  }
                ],
                "text":"Blastobacter"
              }
            ],
            "severity":"severe"
          }
        ]
      }
      
reaction.manifestation Yes List of CodeableConcept
  • Description
    • Clinical symptoms/signs associated with the Event
  • Example
    • {
        {
          "manifestation":[
            {
              "coding":[
                {
                  "system":"http://snomed.info/sct",
                  "code":"414322003"
                }
              ],
              "text":"Blastobacter"
            }
          ]
        }
      }
      
  • Notes
    • Only one manifestation can be provided.
reaction.severity No Code
  • Description
    • mild | moderate | severe (of event as a whole).
  • Example
    • {
        "severity":"severe"
      }
      

Example

Request

POST https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance

Body

{
  "resourceType": "AllergyIntolerance",
  "contained": [
    {
      "resourceType": "PractitionerRole",
      "id": "638995",
      "code": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/practitioner-role",
              "code": "nurse"
            }
          ]
        }
      ]
    }
  ],
  "clinicalStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
        "code": "active"
      }
    ]
  },
  "verificationStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
        "code": "confirmed"
      }
    ]
  },
  "type": "allergy",
  "category": [
    "medication"
  ],
  "criticality": "high",
  "code": {
    "coding": [
      {
        "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code": "723"
      }
    ],
    "text": "amoxicillin"
  },
  "patient": {
    "reference": "Patient/12742399"
  },
  "encounter": {
    "reference": "Encounter/97953523"
  },
  "onsetDateTime": "2019-09-11T05:00:00.000Z",
  "asserter": {
    "reference": "#638995"
  },
  "note": [
    {
      "authorReference": {
        "reference": "Practitioner/12742399"
      },
      "text": "Updated with additional details provided by patient."
    }
  ],
  "reaction": [
    {
      "manifestation": [
        {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "271757001"
            }
          ],
          "text": "Papular eruption"
        }
      ],
      "severity": "severe"
    }
  ]
}

Response

Status: 201 Created
Cache-Control: no-cache
Content-Length: 0
Content-Type: text/html
Date: Wed, 14 Aug 2019 17:23:14 GMT
Etag: W/"6767735"
Location: https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/6767735
Last-Modified: Wed, 14 Aug 2019 17:23:14 GMT
Vary: Origin
X-Request-Id: 11111111111111111111111111111111

The ETag response header indicates the current If-Match version to use on a subsequent update.

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.

Update

Update an existing allergy.

PUT /AllergyIntolerance/:id

Implementation Notes

Authorization Types

Headers

Authorization: <OAuth2 Bearer Token>
Content-Type: application/fhir+json
If-Match: W/"<Current version of the AllergyIntolerance resource>"

Body fields

Notes:

Name Required Type
resourceType Yes string
  • Description
    • The type of the FHIR resource.
  • Example
    • {
        "resourceType": "AllergyIntolerance"
      }
      
  • Notes
    • resourceType must be AllergyIntolerance.
contained No List of Resource
  • Description
    • Contained, inline Resources.
  • Example
    • Contained RelatedPerson
      {
        "contained": [
          {
            "resourceType":"RelatedPerson",
            "id":"638996",
            "relationship":[
              {
                "coding":[
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                    "code": "PRN",
                  }
                ]
              }
            ],
            "patient":{
              "reference":"Patient/12742400"
            }
          }
        ]
      }
      
  • Example
    • Contained PractitionerRole
      {
        "contained": [
          {
            "resourceType":"PractitionerRole",
            "id":"638994",
            "code":[
              {
                "coding":[
                  {
                    "system":"http://terminology.hl7.org/CodeSystem/practitioner-role",
                    "code":"doctor"
                  }
                ]
              }
            ]
          }
        ]
      }
      
  • Notes
    • These should be either PractitionerRole or RelatedPerson resources that are relative references from the asserter field.
clinicalStatus No CodeableConcept
  • Description
    • The clinical status of the AllergyIntolerance.
  • Example
    • {
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
              "code": "resolved"
            }
          ]
        }
      }
      
verificationStatus No CodeableConcept
  • Description
    • The verification status to support or decline the clinical status of allergy.
  • Example
    • {
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
              "code": "confirmed"
            }
          ]
        }
      }
      
  • Notes
    • verificationStatus code of refuted is not supported during AllergyIntolerance updates.
type No code
  • Description
    • allergy | intolerance - Underlying mechanism (if known)
  • Example
    • {
        "type": "allergy"
      }
      
category No List of code
  • Description
    • Category of the identified code.
  • Example
    • {
        "category":[
          "environment",
          "food",
          "medication"
        ]
      }
      
  • Notes
      • Category code of biologic is not supported
      • Only a single category will be written to the allergy
      • When multiple categories are provided, the category to be picked is based on precedence. medication > food > environment.
criticality No List of code
  • Description
    • low | high | unable-to-assess
  • Example
    • {
        "criticality": "high"
      }
      
code Yes CodeableConcept
  • Description
    • Code that identifies the allergy or intolerance
  • Example
    • {
        "code":{
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "9220005"
            }
          ],
          "text": "Plant phenol oil"
        }
      }
      
  • Notes
    • A code must always be provided while creating an allergy.
patient Yes Reference
  • Description
    • Indicates the patient who the sensitivity is for.
  • Example
    • {
        "patient": {
          "reference": "Patient/631923"
        }
      }
      
encounter No Reference
  • Description
    • Indicates the encounter when the allergy or intolerance was asserted.
  • Example
    • {
        "encounter": {
          "reference":"Encounter/1693915"
        }
      }
      
onset[x] No dateTime
  • Description
    • Estimated or actual date or date-time the allergy began, in the opinion of the clinician.
  • Example
    • {
        "onsetDateTime": "2015-10-14T13:13:20-06:00"
      }
      
  • Notes
      • Only a type of dateTime is supported.
      • The dateTime is converted to a GMT date.
asserter No Reference
  • Description
    • Indicates the source of information about the allergy.
  • Example
    • {
        "asserter":{
          "reference":"#638994"
        }
      }
      
  • Notes
    • Asserter must be provided and linked to the contained resource, if a contained resource is specified.
note No List of Annotation
  • Description
    • Additional narrative about the allergy not captured in other fields.
  • Example
    • {
        "note": [
          {
            "text": "Updated with additional details provided by patient."
          }
        ]
      }
      
  • Notes
    • Updates do not allow an author to be specified. One will be infered from the authorization token. If an id is not provided with the note it will be assumed to be a new note and will be written as such. If an id is provided, then it will be assumed to be an existing note and will not be updated or re-created.
reaction No List of BackboneElement
  • Description
    • Adverse Reaction Events linked to exposure to substance
  • Example
    • {
        "reaction":[
          {
            "manifestation":[
              {
                "coding":[
                  {
                    "system":"http://snomed.info/sct",
                    "code":"414322003"
                  }
                ],
                "text":"Blastobacter"
              }
            ],
            "severity":"severe"
          }
        ]
      }
      
reaction.manifestation Yes List of CodeableConcept
  • Description
    • Clinical symptoms/signs associated with the Event
  • Example
    • {
        {
          "manifestation":[
            {
              "coding":[
                {
                  "system":"http://snomed.info/sct",
                  "code":"414322003"
                }
              ],
              "text":"Blastobacter"
            }
          ]
        }
      }
      
  • Notes
    • Only one manifestation can be provided.
reaction.severity No Code
  • Description
    • mild | moderate | severe (of event as a whole).
  • Example
    • {
        "severity":"severe"
      }
      

Example

Request

PUT https://fhir-ehr-code.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d/AllergyIntolerance/12760025

Body

{
  "resourceType": "AllergyIntolerance",
  "id": "12760025",
  "clinicalStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
        "code": "active"
      }
    ]
  },
  "verificationStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
        "code": "unconfirmed"
      }
    ]
  },
  "category": [
    "food"
  ],
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "102263004",
        "display": "Eggs (edible) (substance)"
      }
    ],
    "text": "Egg"
  },
  "patient": {
    "reference": "Patient/12742399"
  },
  "recordedDate": "2019-02-08T00:00:00Z",
  "recorder": {
    "reference": "Practitioner/12724045"
  },
  "note": [
    {
      "text": "Updated with additional details provided by patient."
    }
  ]
}

Response

Status: 200 OK
Cache-Control: no-cache
Content-Length: 0
Content-Type: application/json
Date: Thu, 05 Dec 2019 17:21:08 GMT
Etag: W/"8167765"
Last-Modified: Thu, 05 Dec 2019 17:21:08 GMT
X-Request-Id: a53f6469ff29031e9197b40f526e9ca6
Vary: Origin

The ETag response header indicates the current If-Match version to use on subsequent updates.

Note: The examples provided here are non-normative and replaying them in the public sandbox is not guaranteed to yield the results shown on the site.

Errors

The common errors and OperationOutcomes may be returned.