Allergies and Intolerances

Datasets

US Core 6.1.0 maps each USCDI element to FHIR.

Dataset	US Core 6.1.0 target profile(s)
`allergies`	US Core AllergyIntolerance

allergies

One row per substance per patient. A substance with several reaction manifestations stays one row: list the manifestation codes ;-separated.

Column	Required	Format / values	Example
`patient_identifier`	Yes	patient key	`MRN-4471903`
`substance_code`	Yes	RxNorm ingredient or SNOMED CT code, with `substance_system`; RxNorm if omitted Common substances for allergy and intolerance documentation including refutations	`7980` penicillin G
`clinical_status`	Yes, unless `verification_status` is `entered-in-error`	`active`, `inactive`, `resolved` allergyintolerance-clinical	`active`
`verification_status`	Recommended	`unconfirmed`, `confirmed`, `refuted`, `entered-in-error` allergyintolerance-verification	`confirmed`
`category`	If available	`food`, `medication`, `environment`, `biologic` allergy-intolerance-category	`medication`
`criticality`	If available	`low`, `high`, `unable-to-assess` allergy-intolerance-criticality	`high`
`reaction_manifestation_code`	If a reaction is recorded	SNOMED CT code(s), `;`-separated SNOMED CT Clinical Findings	`247472004` Wheal
`onset_date`	If available	datetime	`2019-05-02`

substance_code is the one coded field with no fallback: a row without it cannot become an AllergyIntolerance. Send substance_system as http://www.nlm.nih.gov/research/umls/rxnorm or http://snomed.info/sct.
For a medication, send the ingredient. Every RxNorm code the value set accepts is an ingredient, single or combination. A code for a specific product or pack, whether an NDC or an RxNorm drug-level code from a pharmacy claim, is not accepted, so roll it up to the ingredient first. For an allergy recorded against a whole drug class, send the SNOMED CT class code.
A row that carries a reaction needs at least one reaction_manifestation_code. Manifestation is mandatory inside a reaction.
clinical_status and verification_status are coupled: FHIR requires clinical_status on every row whose verification_status is not entered-in-error, and forbids it on rows that are. A row that leaves both empty is rejected. Sending active on live rows and resolved or inactive on closed ones satisfies this.

No known allergies

An empty file is ambiguous: it does not separate "we asked, the member has no allergies" from "we never asked". US Core states either case as a row carrying a negation code, and the value set holds one per substance class.

Meaning	`substance_code`	`clinical_status`	`verification_status`
No known allergies at all	`716186003` No known allergy	`active`	`confirmed`
No known drug allergies	`409137002` No known drug allergy	`active`	`confirmed`
No known food allergies	`429625007` No known food allergy	`active`	`confirmed`
No known environmental allergies	`428607008` No known environmental allergy	`active`	`confirmed`
No known latex allergy	`1003774007` No known latex allergy	`active`	`confirmed`
Member was not asked	`1631000175102` Patient not asked	`active`	`unconfirmed`, or empty

All six are SNOMED CT. Use the narrowest one your source supports: a plan that only knows "no drug allergies" should send 409137002, not 716186003.

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