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Concepts/Allergy & Intolerance: Difference between revisions

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|domain=clinical
|domain=clinical
|title=Allergy & Intolerance
|title=Allergy & Intolerance
|summary=A substance that causes a reaction in a patient, with category, criticality, verification, clinical status, occurrence, and notes.
|order=4
|order=4
|introduced=3.0
|introduced=3.0
|fhir=Allergy & Intolerance
|fhir=AllergyIntolerance
|concept=Concepts/Observation
|concept=Concepts/Observation
|reference=References/Allergy Intolerance
|reference=References/Allergy Intolerance
}}
}}


== Definition ==
An '''allergy or intolerance''' records that a patient reacts badly to a particular substance — a food, a medication, an environmental trigger, or a biologic. It is the standing safety flag that warns clinicians before a harmful exposure happens, and lets the platform check new orders against what a patient cannot tolerate.


An '''[https://build.fhir.org/allergyintolerance.html allergy or intolerance]''' in Care is a substance that causes a reaction in a patient. The substance is a food, a medication, an environmental substance, or a biologic substance. Every allergy belongs to one patient. You record it from an encounter of that patient.
== What it represents ==


== Key Attributes ==
In Care's FHIR-aligned model, this maps to the '''AllergyIntolerance''' resource. Each record captures:


{| class="wikitable"
* '''The substance''' — a coded allergen drawn from a curated SNOMED CT list, not free text, so it can be matched against medications and other clinical logic
|-
* '''Clinical status''' — whether the sensitivity is currently active, inactive, or resolved
! Components
* '''Verification status''' — how certain the assertion is, from unconfirmed through confirmed, or even refuted or entered in error
! What it captures
* '''Criticality''' — the potential for serious harm if the patient is exposed again
|-
* '''Category and type''' — what kind of substance it is, and whether it is a true allergy or a non-immune intolerance
| Substance
* '''Timing and notes''' — when it was first recorded, the most recent known reaction, structured onset details, and a free-text clinical note
| The substance that the patient reacts to. You select it from a standard SNOMED CT allergy terminology. There is no default, so you must select one.
|-
| Category
| The type of the substance. The default is Medication.
|-
| Criticality
| The risk of a serious reaction. The default is Low.
|-
| Status
| How certain the record is. The default is Confirmed.
|-
| Clinical Status
| The current clinical state of the allergy. The default is Active.
|-
| Occurrence
| The date when the patient last reacted to the substance. Care does not accept a future date. The default is empty.
|-
| Note
| Free text about the allergy. The default is empty.
|}


=== Category ===
An allergy record is an assertion about a ''risk'', not a log of a reaction that occurred. A single confirmed peanut allergy stays on the record over time even if the patient never reacts again — it is the patient's standing safety profile, distinct from a one-off [[Concepts/Observation]] or a documented [[Concepts/Condition]].


The Category shows the type of the substance. Select one of these values:
== Type and classification ==


* Food
Two distinctions shape how a record reads:
* Medication
* Environment
* Biologic


{{Note|1=You cannot change the Category after you save the allergy.}}
* '''Type''' — an '''allergy''' is an immune-mediated response; an '''intolerance''' is a non-immune adverse reaction (for example, lactose intolerance). The default is allergy.
* '''Category''' — the kind of substance: '''food''', '''medication''', '''environment''', or '''biologic'''. Category is set when the record is created and is fixed thereafter.


=== Criticality ===
'''Criticality''' sits alongside these to express stakes — <code>low</code>, <code>high</code>, or <code>unable_to_assess</code> — answering &quot;how dangerous is the next exposure?&quot; rather than &quot;how sure are we this is real?&quot;, which is what verification status answers.

The Criticality shows the risk of a serious reaction. Select one of these values:

* Low
* High
* Unable to Assess

=== Status ===

The '''Status''' column shows how certain the record is. Select one of these values:

{| class="wikitable"
|-
! Status
! Description
|-
| Unconfirmed
| Care has no confirmation of the allergy.
|-
| Presumed
| The allergy is likely, but nobody confirmed it.
|-
| Confirmed
| Somebody confirmed the allergy.
|-
| Refuted
| Somebody ruled out the allergy.
|-
| Entered in Error
| Somebody recorded the allergy by mistake.
|}

{{Note|1=Care offers Entered in Error only for a saved allergy.}}

=== Clinical Status ===

The Clinical Status shows the current clinical state of the allergy. Set it from the more-options ('''⋮''') menu of the row.

{| class="wikitable"
|-
! Clinical Status
! Description
! Menu item
|-
| Active
| The allergy still applies to the patient.
| '''Mark Active'''
|-
| Inactive
| The allergy no longer applies to the patient.
| '''Mark Inactive'''
|-
| Resolved
| The allergy is over.
| '''Mark Resolved'''
|}

Care shows an inactive allergy in a lighter shade. Care strikes through a resolved allergy.

=== Terminology ===

The substances come from a standard SNOMED CT allergy terminology.

{{Note|1=Your deployment's administrator can change the available terminology.}}


== Lifecycle ==
== Lifecycle ==


You record and change allergies from the '''Overview''' tab of the encounter. Use the '''Allergies''' section, or use the '''Allergy''' quick action.
A record carries two independent status axes. Clinical status tracks whether the sensitivity is live; verification status tracks how trustworthy the assertion is.


While the encounter is open, you can change the Criticality, the Status, the Clinical Status, the Occurrence, and the Note of a saved allergy. You cannot change the Substance or the Category after you save the allergy.
<syntaxhighlight lang="text">Clinical status: active → inactive → resolved
Verification status: unconfirmed → presumed → confirmed
↘ refuted / entered_in_error</syntaxhighlight>
* '''active''' — the allergy is currently relevant to the patient's care
* '''inactive''' — no longer considered active, but kept for history
* '''resolved''' — the patient is believed to have outgrown or recovered from the sensitivity
* '''unconfirmed / presumed / confirmed''' — increasing levels of certainty that the allergy is real
* '''refuted''' — investigated and found not to be a genuine allergy
* '''entered_in_error''' — recorded by mistake; flagged so it no longer drives safety logic


All add and edit controls are read-only when the encounter status is Completed, Cancelled, Discontinued, or Entered in Error.
These axes move independently: a record can be clinically <code>active</code> yet only <code>unconfirmed</code>, and a <code>refuted</code> allergy is kept rather than deleted so the decision is auditable.


Care never deletes a saved allergy. To retract one, set its Status to Entered in Error. Care then leaves the allergy out of the '''Allergies''' section and out of the allergy history.
== How it connects ==


Care links each allergy to the encounter where you last recorded or changed it. If you change an allergy from a later encounter, Care keeps the earlier version with the first encounter.
* '''Patient''' — every allergy belongs to one [[Concepts/Patient|patient]] and is part of their standing clinical profile. The patient is derived automatically and is never set by the client.

* '''Encounter''' — each allergy is recorded against the [[Concepts/Encounter|encounter]] in which a clinician asserted it, anchoring it to a moment in the patient's timeline. Records are tied to both, so an allergy never outlives the patient or encounter it belongs to.
Allergies stay with the patient. The allergy history of the patient shows them across all encounters.
* '''Medications''' — because the substance is a code from a curated value set rather than free text, an allergy can be matched against a [[Concepts/Medication Request|medication request]] and other ordering logic, instead of relying on a clinician to read a note.


== Permissions ==
== Permissions ==


Your role controls what you can do with an allergy.
Allergy and intolerance records have no permission file of their own — as patient clinical data, they are governed by the '''patient''' and '''encounter''' permissions a user holds in the relevant facility. Recording an allergy is gated by write access to the patient; reading is allowed by the patient's clinical-data permission, or, failing that, by the encounter's clinical-data read permission for a specified encounter; editing is gated by write access to the encounter's clinical data.


{| class="wikitable"
{| class="wikitable"
|-
|-
! Permission
! Permission
! What it allows
! Description
! System Roles
|-
|-
| Can submit questionnaire about patient encounters
| <code>can_write_patient</code>
| Submit the allergy screen of an encounter.
| Create an allergy record — the create path checks write access to the patient
| Staff, Doctor, Nurse, Administrator, Admin, Facility Admin
|-
|-
| Can Update a Patient's data
| <code>can_view_clinical_data</code>
| Record a new allergy for the patient.
| View a patient's clinical data, including their allergies and intolerances
| Staff, Doctor, Nurse, Admin, Facility Admin
|-
|-
| Update Encounter related clinical data
| <code>can_read_encounter_clinical_data</code>
| Change or retract an allergy of an encounter.
| Read an encounter's clinical data — the fallback used to reach allergies when patient-level clinical access is absent, scoped to the matching encounter
| Admin, Doctor, Nurse, Facility Admin
|-
|-
| Can view clinical data about patients
| <code>can_write_encounter_clinical_data</code>
| View the allergies of a patient.
| Update an allergy record — the update path checks write access to its encounter's clinical data
|-
| Admin, Doctor, Nurse, Facility Admin
| Can Read encounter related clinical data
| View the allergies of one encounter.
|}
|}


By default, doctors, nurses, administrators, and facility administrators can record and change allergies. Staff can view patient clinical data, but staff do not have encounter clinical-data access.
Roles are granted to users through organization, facility, and patient memberships; permissions cascade down the organization tree, so a role held higher up applies to the facilities and patients beneath it.



== FHIR reference ==
== FHIR R5 alignment ==


Care follows FHIR R5 for allergies. The substance, the category, the criticality, the verification status, the clinical status, the last occurrence, and the note map to the FHIR AllergyIntolerance resource.
This concept aligns with the FHIR '''AllergyIntolerance''' resource, which represents a clinician's assertion of a patient's propensity for an adverse reaction to a substance. Care follows its core structure — coded substance, clinical and verification status, criticality, category, and type.


{{Navbox clinical}}
{{Navbox clinical}}


{{Related}}
{{Related}}
Wiki: ohcnwiki.tellmey.fyi

Latest revision as of 17:11, 14 August 2026

conceptclinicalFHIR: AllergyIntoleranceCARE 3.0+

Definition

An allergy or intolerance in Care is a substance that causes a reaction in a patient. The substance is a food, a medication, an environmental substance, or a biologic substance. Every allergy belongs to one patient. You record it from an encounter of that patient.

Key Attributes

Components What it captures
Substance The substance that the patient reacts to. You select it from a standard SNOMED CT allergy terminology. There is no default, so you must select one.
Category The type of the substance. The default is Medication.
Criticality The risk of a serious reaction. The default is Low.
Status How certain the record is. The default is Confirmed.
Clinical Status The current clinical state of the allergy. The default is Active.
Occurrence The date when the patient last reacted to the substance. Care does not accept a future date. The default is empty.
Note Free text about the allergy. The default is empty.

Category

The Category shows the type of the substance. Select one of these values:

  • Food
  • Medication
  • Environment
  • Biologic
📝 Note
You cannot change the Category after you save the allergy.

Criticality

The Criticality shows the risk of a serious reaction. Select one of these values:

  • Low
  • High
  • Unable to Assess

Status

The Status column shows how certain the record is. Select one of these values:

Status Description
Unconfirmed Care has no confirmation of the allergy.
Presumed The allergy is likely, but nobody confirmed it.
Confirmed Somebody confirmed the allergy.
Refuted Somebody ruled out the allergy.
Entered in Error Somebody recorded the allergy by mistake.
📝 Note
Care offers Entered in Error only for a saved allergy.

Clinical Status

The Clinical Status shows the current clinical state of the allergy. Set it from the more-options (⋮) menu of the row.

Clinical Status Description Menu item
Active The allergy still applies to the patient. Mark Active
Inactive The allergy no longer applies to the patient. Mark Inactive
Resolved The allergy is over. Mark Resolved

Care shows an inactive allergy in a lighter shade. Care strikes through a resolved allergy.

Terminology

The substances come from a standard SNOMED CT allergy terminology.

📝 Note
Your deployment's administrator can change the available terminology.

Lifecycle

You record and change allergies from the Overview tab of the encounter. Use the Allergies section, or use the Allergy quick action.

While the encounter is open, you can change the Criticality, the Status, the Clinical Status, the Occurrence, and the Note of a saved allergy. You cannot change the Substance or the Category after you save the allergy.

All add and edit controls are read-only when the encounter status is Completed, Cancelled, Discontinued, or Entered in Error.

Care never deletes a saved allergy. To retract one, set its Status to Entered in Error. Care then leaves the allergy out of the Allergies section and out of the allergy history.

Care links each allergy to the encounter where you last recorded or changed it. If you change an allergy from a later encounter, Care keeps the earlier version with the first encounter.

Allergies stay with the patient. The allergy history of the patient shows them across all encounters.

Permissions

Your role controls what you can do with an allergy.

Permission What it allows
Can submit questionnaire about patient encounters Submit the allergy screen of an encounter.
Can Update a Patient's data Record a new allergy for the patient.
Update Encounter related clinical data Change or retract an allergy of an encounter.
Can view clinical data about patients View the allergies of a patient.
Can Read encounter related clinical data View the allergies of one encounter.

By default, doctors, nurses, administrators, and facility administrators can record and change allergies. Staff can view patient clinical data, but staff do not have encounter clinical-data access.

FHIR R5 alignment

Care follows FHIR R5 for allergies. The substance, the category, the criticality, the verification status, the clinical status, the last occurrence, and the note map to the FHIR AllergyIntolerance resource.

Pages that link here:

Fast Healthcare Interoperability Resources — an HL7 standard for exchanging healthcare data. CARE is built on FHIR R5.

Open Healthcare Network's flagship product: an open-source, FHIR-native electronic medical record (EMR) and healthcare operating system.

A comprehensive clinical terminology used to code diagnoses, findings and procedures.

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